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目的 :本研究旨在验证急性冠状动脉综合征(ACS)患者使用冠状动脉介入治疗的性别差异。方法 :对墨尔本一家大型城市医院2009-2012年住院的2096例ACS患者数据库进行了回顾性分析。ACS包括不稳定型心绞痛(UA)、ST段抬高型心肌梗死(STEMI)和非ST段抬高型心肌梗死(NSTEMI)。结果 :患者的平均年龄为64.3岁,其中624例(30%)为女性。一半病例被诊断为NSTEMI,23%的病例为STEMI,25%的病例为UA。与男性患者相比,女性患者入院时年龄较大,诊断为STEMI的比例较低,吸烟率较低;在严重共存病或使用冠状动脉造影方面,未观察到性别差异。诊断为STEMI的病例中,女性患者接受血管成形术支架的比例比男性患者低39%(调整OR=0.61,95%可信区间为0.39~0.96);接受冠状动脉旁路移植术的比例比男性患者低66%(调整OR=0.34,95%可信区间为0.13~0.93)。诊断为NSTEMI的病例中,女性患者接受冠状动脉旁路移植术的比例比男性患者低44%(调整OR=0.56,95%可信区间为0.37~0.83)。35~49岁的年轻病例中,女性患者接受血管成形术支架的比例低于男性患者;50岁以上的年长病例中,女性患者接受冠状动脉旁路移植术的比例低于男性患者。结论 :坚持以指南为基础的治疗,将有助于确保知识从指南到临床实践的转换。在进一步的研究中,调查临床表现,根据性别对ACS进行无创性检查和医学干预,也许可以更深入地解释冠状动脉介入治疗的性别差异。
Purpose: This study was designed to validate the gender differences in the use of coronary intervention in patients with acute coronary syndrome (ACS). METHODS: A retrospective analysis of 2096 ACS patients hospitalized in a large urban hospital in Melbourne from 2009 to 2012 was conducted. ACS includes unstable angina (UA), ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Results: The mean age of patients was 64.3 years, of whom 624 (30%) were women. Half of the cases were diagnosed with NSTEMI, 23% were STEMI, and 25% were UA. Female patients were older at admission, had a lower rate of STEMI diagnoses and lower rates of smoking than men, and no gender differences were observed in severe co-morbidities or coronary angiography. Among STEMI-diagnosed cases, the percentage of female patients undergoing angioplasty stents was 39% lower than that of male patients (adjusted OR = 0.61, 95% confidence interval 0.39 to 0.96); the proportion of patients undergoing coronary artery bypass grafting was significantly lower than that of male Patients were 66% lower (adjusted OR = 0.34, 95% confidence interval 0.13 to 0.93). Among patients diagnosed with NSTEMI, the percentage of female patients undergoing coronary artery bypass grafting was 44% lower than that of male patients (adjusted OR = 0.56; 95% confidence interval, 0.37-0.83). Among young patients aged 35 to 49 years, the proportion of female patients undergoing angioplasty stenting was lower than that of male patients; in elderly patients over the age of 50, the proportion of female patients undergoing coronary artery bypass grafting was lower than that of male patients. Conclusion: Adherence to guideline-based care will help ensure the conversion of knowledge from guidance to clinical practice. In further studies, investigating clinical manifestations, noninvasive examination of ACS based on gender, and medical intervention may explain more deeply the gender differences in coronary intervention.