SELECTION OF PATIENTS FOR CORONARY ANGIOGRAPHY AND CORONARY REVASCULARIZATION EARLY AFTER MYOCARDIAL-INFARCTION - IS THERE EVIDENCE FOR A GENDER BIAS
SELECTION OF PATIENTS FOR CORONARY ANGIOGRAPHY AND CORONARY REVASCULARIZATION EARLY AFTER MYOCARDIAL-INFARCTION - IS THERE EVIDENCE FOR A GENDER BIAS
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DOI：
10.7326/0003-4819-116-10-785
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发表时间：
1992-05-15
影响因子：
39.2
通讯作者：
PASTERNAK, RC
中科院分区：
文献类型：
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作者：
KRUMHOLZ, HM;DOUGLAS, PS;PASTERNAK, RC
目的：确定在心肌梗死后早期选择诊断和治疗心血管手术的患者中是否存在性别偏见。设计：回顾性队列研究。环境：社区三级护理教学医院。患者：共有2473例连续患者，主要出院诊断为急性心肌梗死，峰值肌酸激酶MB分数至少为4%。测量方法：比较男性和女性接受各种心脏手术的频率。结果：女性因心肌梗死住院期间进行冠状动脉造影的频率远低于男性（优势比，0.55;95% Cl， 0.46至0.65），但男女经年龄调整后的发生率相似（优势比，0.91;Cl， 0.75至1.12）。异常射血分数（< 50%）在接受左心室造影的女性和男性中同样常见（优势比，0.85;Cl, 0.56 ~ 1.30）。在接受冠状动脉造影的患者中，女性患严重冠状动脉疾病的比例明显较低，严重冠状动脉疾病的定义为左主干狭窄超过50%，三支血管疾病，或两支血管疾病，左前降支近端狭窄超过70%（优势比，0.67;Cl， 0.48至0.93）。在对年龄进行调整后，女性接受经皮腔内冠状动脉成形术的频率与男性相同（优势比，1.16;Cl, 0.83 ~ 1.62），但接受冠状动脉搭桥手术的频率明显低于男性（优势比，0.58;Cl, 0.37 ~ 0.91）。当对年龄和冠状动脉疾病的严重程度进行调整时，两者的差异具有临界显著性（优势比，0.65;Cl, 0.41 ~ 1.01）。结论：在年龄调整后，没有证据表明女性和男性在心肌梗死后早期冠状动脉造影率有差异。在心肌梗死后早期接受心导管插入术的患者中，女性和男性接受血管成形术的可能性相同，但女性接受冠状动脉搭桥手术的可能性低于男性。
Objective: To determine whether a gender bias exists in the selection of patients for diagnostic and therapeutic cardiovascular procedures early after myocardial infarction.Design: A retrospective cohort study.Setting: A community-based tertiary care teaching hospital.Patients: A total of 2473 consecutive patients with a principal discharge diagnosis of acute myocardial infarction and a peak creatine kinase MB fraction of at least 4%.Measurements: Comparison of men and women regarding the frequency with which they underwent various cardiac procedures.Results: Women had coronary angiography during hospitalization for myocardial infarction much less frequently than men (odds ratio, 0.55; 95% Cl, 0.46 to 0.65), but the age-adjusted rates were similar in women and men (odds ratio, 0.91; Cl, 0.75 to 1.12). An abnormal ejection fraction (< 50%) was equally frequent in women and men who underwent left ventriculography (odds ratio, 0.85; Cl, 0.56 to 1.30). Among patients who had coronary angiography, women had a significantly lower rate of severe coronary artery disease, defined as either a left main stenosis of more than 50%, three-vessel disease, or two-vessel disease with a proximal left anterior descending stenosis of more than 70% (odds ratio, 0.67; Cl, 0.48 to 0.93). When adjustments were made for age, women had percutaneous transluminal coronary angioplasty as often as men (odds ratio, 1.16; Cl, 0.83 to 1.62) but had coronary artery bypass graft surgery significantly less frequently (odds ratio, 0.58; Cl, 0.37 to 0.91). When adjustments were made for age and the severity of coronary artery disease, the difference in rates was of borderline significance (odds ratio, 0.65; Cl, 0.41 to 1.01).Conclusions: No evidence of a difference in the rate of coronary angiography early after myocardial infarction between women and men was found after age adjustment. Among patients who have cardiac catheterization early after myocardial infarction, women and men are equally likely to have angioplasty, but women are less likely than men to have coronary artery bypass surgery.