Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes
Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes
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DOI：
10.1016/j.jacc.2004.11.055
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发表时间：
2005-03-15
影响因子：
24
通讯作者：
Newby, LK
中科院分区：
文献类型：
--
作者：
Blomkalns, AL;Chen, AY;Newby, LK
我们假设在非ST段抬高（NSTE）急性冠状动脉综合征（ACS）患者的治疗中存在显著的性别差异。自修订的美国心脏病学会/美国心脏协会NSTE ACS患者管理指南出版以来，尚未完成对这些差异的大规模检查。（不稳定型心绞痛患者的快速风险分层能否通过早期实施美国心脏病学会/美国心脏协会指南抑制不良结局）国家质量改进倡议，我们检查了NSTE ACS患者治疗和结果的性别差异。结果女性（35，875例患者中的41%）年龄较大（中位年龄73岁对65岁），更常患有糖尿病和高血压。女性患者不太可能接受急性肝素、血管紧张素转换酶抑制剂和糖蛋白IIb/IIIa抑制剂，出院时不太常接受阿司匹林、血管紧张素转换酶抑制剂和他汀类药物。心脏导管插入术和血运重建术在男性中的使用率较高，但在患有严重冠状动脉疾病的患者中，经皮血运重建术在女性和男性中的比例相似。女性在未经调整的住院死亡风险较高（5.6% vs. 4.3%），再梗死（4.0% vs. 3.5%），心力衰竭（12.1% vs. 8.8%），卒中（1.1% vs. 0.8%）和红细胞输注（17.2%对13.2%），但调整后，只有输血是更高的妇女。结论尽管呈现出较高的风险特征，并有较高的住院风险，患有NSTE ACS的女性的治疗积极性低于男性。(c)2005年，美国心脏病学会基金会。
OBJECTIVES We hypothesized that significant disparities in gender exist in the management of patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS).BACKGROUND Gender-related differences in the diagnosis and treatment of ACS have important healthcare implications. No large-scale examination of these disparities has been completed since the publication of the revised American College of Cardiology/American Heart Association guidelines for management of patients with NSTE ACS.METHODS Using data from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative, we examined differences of gender in treatment and outcomes among patients with NSTE ACS.RESULTS Women (41% of 35,875 patients) were older (median age 73 vs. 65 years) and more often had diabetes and hypertension. Women were less likely to receive acute heparin, angiotensin-converting enzyme inhibitors, and glycoprotein IIb/IIIa inhibitors and less commonly received aspirin, angiotensin-converting enzyme inhibitors, and statins at discharge. The use of cardiac catheterization and revascularization was higher in men, but among patients with significant coronary disease, percutaneous revascularization was performed in a similar proportion of women and men. Women were at higher risk for unadjusted in-hospital death (5.6% vs. 4.3%), reinfarction (4.0% vs. 3.5%), heart failure (12.1% vs. 8.8%), stroke (1.1% vs. 0.8%), and red blood cell transfusion (17.2% vs. 13.2%), but after adjustment, only transfusion was higher in women.CONCLUSIONS Despite presenting with higher risk characteristics and having higher in-hospital risk, women with NSTE ACS are treated less aggressively than men. (c) 2005 by the American College of Cardiology Foundation.