Sex differences in long-term mortality after myocardial infarction: a systematic review.
Sex differences in long-term mortality after myocardial infarction: a systematic review.
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DOI：
10.1161/circulationaha.114.009480
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发表时间：
2014-08-26
期刊：
影响因子：
37.8
通讯作者：
Krumholz HM
中科院分区：
文献类型：
--
作者：
Bucholz EM;Butala NM;Rathore SS;Dreyer RP;Lansky AJ;Krumholz HM
关于急性心肌梗死(AMI)后长期死亡率的性别差异的研究报告结果喜忧参半。需要进行系统的审查，以确定关于长期结果中的性别差异的已知情况，并确定知识中的差距。我们搜索了1966年至2012年12月的Medline数据库，以确定所有提供急性心肌梗死后死亡率性别比较的研究。只有至少有五年随访期的研究才被回顾。在1,877篇已确定的摘要中，有52篇研究符合纳入标准，其中39篇被纳入本综述。大多数研究包括不到三分之一的女性。在患者群体、方法学和风险调整方面的研究存在显著的异质性，这导致了风险估计的显著差异。总体而言，大多数研究报告称，在急性心肌梗死后5年和10年，女性的未调整死亡率高于男性；然而，在对年龄进行调整后，死亡率的许多差异变得减弱。不同研究的多变量模型各不相同；然而，大多数报告称，在对年龄以外的协变量进行调整后，性别差异进一步缩小。很少有研究研究性别与年龄的相互作用；然而，有几项研究报告了性别和治疗之间的相互作用，即女性在血运重建后的死亡风险与男性相似。急性心肌梗死后长期死亡率的性别差异在很大程度上是由于男女在年龄、合并症和治疗利用方面的差异。未来的研究应该致力于澄清这些风险因素和表现形式上的差异如何导致死亡率的性别差异。
Studies of sex differences in long-term mortality after acute myocardial infarction (AMI) have reported mixed results. A systematic review is needed to characterize what is known about sex differences in long-term outcomes and to define gaps in knowledge. We searched the Medline database from 1966 to December 2012 to identify all studies that provided sex-based comparisons of mortality after AMI. Only studies with at least five years of follow-up were reviewed. Of the 1,877 identified abstracts, 52 studies met inclusion criteria, of which 39 were included in this review. Most studies included less than one-third women. There was significant heterogeneity across studies in patient populations, methodology, and risk adjustment, which produced substantial variability in risk estimates. In general, most studies reported higher unadjusted mortality for women compared with men at both 5 and 10 years after AMI; however, many of the differences in mortality became attenuated after adjustment for age. Multivariable models varied between studies; however, most reported a further reduction in sex differences after adjustment for covariates other than age. Few studies examined sex-by-age interactions; however several studies reported interactions between sex and treatment, whereby women have similar mortality risk as men after revascularization. Sex differences in long-term mortality after AMI are largely explained by differences in age, comorbidities, and treatment utilization between women and men. Future research should aim to clarify how these differences in risk factors and presentation contribute to the sex gap in mortality.