IN-HOSPITAL AND 1-YEAR MORTALITY IN 1,524 WOMEN AFTER MYOCARDIAL-INFARCTION - COMPARISON WITH 4,315 MEN
IN-HOSPITAL AND 1-YEAR MORTALITY IN 1,524 WOMEN AFTER MYOCARDIAL-INFARCTION - COMPARISON WITH 4,315 MEN
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DOI：
10.1161/01.cir.83.2.484
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发表时间：
1991-02-01
期刊：
影响因子：
37.8
通讯作者：
BEHAR, S
中科院分区：
文献类型：
--
作者：
GREENLAND, P;REICHERREISS, H;BEHAR, S
我们在1981-1983年间对来自以色列21个冠心病监护病房中的14个的5839名患者的急性心肌梗死(MI)后的住院和1年预后进行了研究。年龄调整后的住院死亡率在1,524名女性中为23.1%，在4,315名男性中为15.7%(p<；0.0005)。住院患者的一年年龄调整死亡率女性为11.8%，男性为9.3%(p=0.03)。年龄调整后的1年累计死亡率女性为31.8%，男性为23.1%(p<；0.0005)。对年龄、既往心肌梗死、充血性心力衰竭和心梗部位等主要预后因素进行协变量调整后的相对死亡率显示，女性在住院期间(相对优势1.72；95%可信区间1.45-2.04)和出院一年(相对优势1.32；95%可信区间1.05-1.66)都与死亡率的增加独立且显著相关。在对每个性别的单独的多变量分析中，一个主要因素被认为是预测女性预后的因素，但不是男性，是报告的糖尿病病史，无论是住院死亡率还是1年死亡率。然而，即使在这一人群中的非糖尿病患者中，女性性别也是住院死亡率的重要独立预测因素。本研究的结果证实，女性在遭受急性心肌梗死后的情况比男性更糟，年龄的增加并不能完全解释女性死亡率的增加，而且一旦发生心肌梗死，糖尿病女性的风险尤其高。
We determined in-hospital and 1-year prognoses after acute myocardial infarction (MI) in 5,839 consecutive patients derived from 14 of 21 coronary care units in Israel during 1981-1983. Age-adjusted in-hospital mortality was 23.1% in 1,524 women and 15.7% in 4,315 men (p < 0.0005). One-year age-adjusted mortality rates in patients surviving hospitalization were 11.8% in women and 9.3% in men (p = 0.03). Cumulative age-adjusted 1-year mortality rates were 31.8% in women and 23.1% in men (p < 0.0005). Relative odds of mortality, covariate-adjusted for major prognostic factors that included age, prior MI, congestive heart failure, and infarct location by electrocardiogram, indicated that female gender was independently and significantly associated with increased mortality both during hospitalization (relative odds, 1.72; 95% confidence interval, 1.45-2.04) and at 1 year after discharge (relative odds, 1.32; 95% confidence interval, 1.05-1.66). In separate multivariate analyses for each gender, a major factor that emerged as a predictor of outcome in women, but not in men, was a reported history of diabetes mellitus, both for in-hospital mortality and for 1-year mortality. However, even in the nondiabetics in this population, female gender was a significant, independent predictor of in-hospital mortality. The findings of the present study substantiate that women fare worse than men after suffering an acute MI, that increased age does not fully account for the increased mortality in women, and that diabetic women are at particularly high risk once MI has occurred.