Sex differences in mortality following acute coronary syndromes.
Sex differences in mortality following acute coronary syndromes.
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DOI：
10.1001/jama.2009.1227
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发表时间：
2009-08-26
影响因子：
120.7
通讯作者：
Douglas, Pamela S.
中科院分区：
文献类型：
--
作者：
Berger, Jeffrey S.;Elliott, Laine;Gallup, Dianne;Roe, Matthew;Granger, Christopher B.;Armstrong, Paul W.;Simes, R. John;White, Harvey D.;Van de Werf, Frans;Topol, Eric J.;Hochman, Judith S.;Newby, L. Kristin;Harrington, Robert A.;Califf, Robert M.;Becker, Richard C.;Douglas, Pamela S.
关于性别差异是否调节急性冠状动脉综合征（ACS）后的短期死亡率，存在相互矛盾的信息。研究性别与ACS患者30天死亡率之间的关系，并使用ACS谱的大型数据库并调整潜在的混淆临床协变量，确定这种关系是否受到临床综合征或冠状动脉解剖结构的影响。从1993年至2006年的11个ACS试验的数据汇总。在136，247例患者中，38，048例（28%）为女性; 102，004例（26%女性）STEMI，14，466例（29%女性）NSTEMI和19，777例（40%女性）不稳定型心绞痛（UA）。ACS后30天死亡率。30天时女性死亡率为9.6%，男性为5.3%（比值比[OR] 1.91，95%置信区间[CI] 1.83-2.00）。多变量校正后，女性和男性之间的死亡率无显著差异（校正OR 1.06，95%CI 0.99-1.15）。重要的是，ACS类型与性别之间存在显著的相互作用（P<0.001）。在STEMI中，女性的30天死亡率较高（调整后OR 1.15，95% CI 1.06-1.24），而NSTEMI（调整后OR 0.77，95% CI 0.63-0.95），女性的UA死亡率较低（调整后OR 0.55，95% CI 0.43-0.70）。在35，128例有血管造影数据的患者队列中，无论ACS类型如何，女性更常患有非阻塞性（15% vs. 8%）冠状动脉疾病，而较少患有2支（25% vs. 28%）和3支（23% vs. 26%）冠状动脉疾病。在对血管造影疾病严重程度进行额外调整后，无论ACS类型如何，女性的30天死亡率与男性无显著差异。性别与30天死亡率之间的关系在血管造影疾病严重程度水平上相似（相互作用的p值=0.70），ACS患者的30天死亡率存在性别差异，并因临床表现而异。然而，在调整临床差异和血管造影数据后，这些差异明显减弱。
There is conflicting information about whether sex-differences modulate short-term mortality following acute coronary syndromes (ACS). To investigate the relationship between sex and 30-day mortality in ACS, and determine whether this relationship is modified by clinical syndrome or coronary anatomy using a large database across the spectrum of ACS and adjusting for potentially confounding clinical covariates. Data from 11 ACS trials from 1993 to 2006 were pooled. Of 136,247 patients, 38,048 (28%) were women; 102,004 (26% women) STEMI, 14,466 (29% women) NSTEMI and 19,777 (40% women) unstable angina (UA). Thirty-day mortality following ACS. Mortality at 30 days was 9.6% in women and 5.3% in men (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.83–2.00). After multivariable adjustment, mortality was not significantly different between women and men (adjusted OR 1.06, 95% CI 0.99–1.15). Importantly, a significant sex by type of ACS interaction was demonstrated (P<0.001). In STEMI, 30-day mortality was higher among women (adjusted OR 1.15, 95% CI 1.06–1.24), whereas NSTEMI (adjusted OR 0.77, 95% CI 0.63–0.95), and UA mortality was lower among women (adjusted OR 0.55, 95% CI 0.43–0.70). In a cohort of 35,128 patients with angiographic data, women more often had non-obstructive (15% vs. 8%,) and less often had 2-vessel (25% vs. 28%) and 3-vessel (23% vs. 26%) coronary disease regardless of ACS type. After additional adjustment for angiographic disease severity, 30-day mortality among women was not significantly different than men, regardless of ACS type. The relationship between sex and 30-day mortality was similar across the levels of angiographic disease severity (p-value for interaction =0.70), Sex-based differences exist in 30-day mortality among ACS patients and vary depending on clinical presentation. However, these differences are markedly attenuated following adjustment for clinical differences and angiographic data.
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影响因子：
37.8
作者：
FARB, A;TANG, AL;VIRMANI, R
通讯作者：
VIRMANI, R
影响因子：
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作者：
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通讯作者：
Newby, LK