Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality.
Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality.
复制标题
DOI：
10.1001/jama.2012.199
复制
发表时间：
2012-02-22
影响因子：
120.7
通讯作者：
Zheng, Zhi-Jie
中科院分区：
文献类型：
--
作者：
Canto, John G.;Rogers, William J.;Goldberg, Robert J.;Peterson, Eric D.;Wenger, Nanette K.;Vaccarino, Viola;Kiefe, Catarina I.;Frederick, Paul D.;Sopko, George;Zheng, Zhi-Jie
女性在因心肌梗死(MI)住院时通常比男性年龄大，而且出现胸痛/不适的频率也较低。然而，很少有研究在检查临床表现和死亡率的性别差异时将年龄考虑在内。研究性别与症状表现之间的关系，以及性别、症状表现与住院死亡率之间的关系，以及考虑年龄前后的关系。1994-2006年国家心肌梗死登记处对1143 513名登记患者(481581名女性和661 932名男性)进行了观察性研究。我们研究了无胸痛的心肌梗死的预测因素，以及年龄、性别和住院死亡率之间的关系。女性MI患者中无胸痛的比例显著高于男性(42.0%[95%CI，41.8%-42.1%]vs 30.7%[95%CI，30.6%-30.8%]；P<；.001)。年龄和性别与胸痛有显著的交互作用，年轻患者的性别差异大于年龄较大的患者，这种差异随着年龄的增长而减弱。女性(参照，男性)无胸痛的多变量调整年龄比(OR)小于45岁，1.30(95%CI，1.23~1.36)；45~54岁，1.26(95%CI，1.22~1.30)；55~年，1.24(95%CI，1.21~1.27)；65~74岁，1.13(95%CI，1.11~1.15)；75岁及以上，1.03(95%可信区间，1.02~1.04)。双向交互作用(性别和年龄)对无胸痛的MI表现有显著意义(P<；.001)。住院死亡率女性为14.6%，男性为10.3%。无胸痛的年轻女性比无胸痛的年轻男性住院死亡率高，且这些性别差异随着年龄的增长而减小甚至逆转，调整后的OR年龄小于45岁，1.18(95%CI，1.00-1.39)；45-54岁，1.13(95%CI，1.02-1.26)；55-岁，1.02(95%CI，0.96-1.09)；65-74岁，0.91(95%CI，0.88-0.95)；75岁及以上，0.81(95%CI，0.79~0.83)。3向交互作用(性别、年龄和胸痛)对死亡率有显著影响(P<；.001)。在这个心肌梗塞住院患者的登记中，女性比男性更有可能出现无胸痛，并且死亡率高于相同年龄组的男性，但在无胸痛的临床表现和死亡率方面的性别差异随着年龄的增长而减弱。
Women are generally older than men at hospitalization for myocardial infarction (MI) and also present less frequently with chest pain/discomfort. However, few studies have taken age into account when examining sex differences in clinical presentation and mortality. To examine the relationship between sex and symptom presentation and between sex, symptom presentation, and hospital mortality, before and after accounting for age in patients hospitalized with MI. Observational study from the National Registry of Myocardial Infarction, 1994-2006, of 1 143 513 registry patients (481 581 women and 661 932 men). We examined predictors of MI presentation without chest pain and the relationship between age, sex, and hospital mortality. The proportion of MI patients who presented without chest pain was significantly higher for women than men (42.0% [95% CI, 41.8%-42.1%] vs 30.7% [95% CI, 30.6%-30.8%]; P< .001). There was a significant interaction between age and sex with chest pain at presentation, with a larger sex difference in younger than older patients, which became attenuated with advancing age. Multivariable adjusted age-specific odds ratios (ORs) for lack of chest pain for women (referent, men) were younger than 45 years, 1.30 (95% CI, 1.23-1.36); 45 to 54 years, 1.26 (95% CI, 1.22-1.30); 55 to 64 years, 1.24 (95% CI, 1.21-1.27); 65 to 74 years, 1.13 (95% CI, 1.11-1.15); and 75 years or older, 1.03 (95% CI, 1.02-1.04). Two-way interaction (sex and age) on MI presentation without chest pain was significant (P<.001). The in-hospital mortality rate was 14.6% for women and 10.3% for men. Younger women presenting without chest pain had greater hospital mortality than younger men without chest pain, and these sex differences decreased or even reversed with advancing age, with adjusted OR for age younger than 45 years, 1.18 (95% CI, 1.00-1.39); 45 to 54 years, 1.13 (95% CI, 1.02-1.26); 55 to 64 years, 1.02 (95% CI, 0.96-1.09); 65 to 74 years, 0.91 (95% CI, 0.88-0.95); and 75 years or older, 0.81 (95% CI, 0.79-0.83). The 3-way interaction (sex, age, and chest pain) on mortality was significant (P< .001). In this registry of patients hospitalized with MI, women were more likely than men to present without chest pain and had higher mortality than men within the same age group, but sex differences in clinical presentation without chest pain and in mortality were attenuated with increasing age.
登录
查看更多内容
影响因子：
--
作者：
Vaccarino, Viola;Parsons, Lori;Peterson, Eric D.;Rogers, William J.;Kiefe, Catarina I.;Canto, John
通讯作者：
Canto, John
影响因子：
24
作者：
Virmani, R;Burke, AP;Kolodgie, FD
通讯作者：
Kolodgie, FD
影响因子：
24
作者：
Blomkalns, AL;Chen, AY;Newby, LK
通讯作者：
Newby, LK
影响因子：
120.7
作者：
Canto, JG;Shlipak, MG;Kiefe, CI
通讯作者：
Kiefe, CI
影响因子：
158.5
作者：
Hochman, JS;Tamis, JE;Califf, RM
通讯作者：
Califf, RM