Differences in admission rates and outcomes between men and women presenting to emergency departments with coronary syndromes
Differences in admission rates and outcomes between men and women presenting to emergency departments with coronary syndromes
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DOI：
10.1503/cmaj.060711
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发表时间：
2007-11-06
影响因子：
14.6
通讯作者：
Armstrong, Paul W.
中科院分区：
文献类型：
--
作者：
Kaul, Padma;Chang, Wei-Ching;Armstrong, Paul W.
背景：以往研究冠心病治疗中性别差异的研究主要集中在住院患者。我们试图在急诊科护理的早期阶段检查与性别相关的差异。方法：我们收集了1998年7月至2001年3月期间因急性心肌梗死、不稳定型心绞痛、稳定型心绞痛或胸痛而到阿尔伯塔急诊科就诊的54134名患者（44%为女性）的门诊护理和住院数据。我们使用逻辑回归和考克斯回归分析来确定在调整年龄、合并症和社会经济因素后，1年内从急诊室出院或冠状动脉血运重建的可能性与1年死亡率之间的性别特异性相关性。急诊就诊后，91.3%的急性心肌梗死患者，87.4%的不稳定型心绞痛患者，40.7%的稳定型心绞痛患者和19.8%的胸痛患者入院治疗。女性比男性更容易从急诊科出院：急性心肌梗死的校正比值比（和95%置信区间[CI]）为2.25（1.75-2.90），不稳定型心绞痛为1.71（1.45-2.01），稳定型心绞痛为1.33（1.15-1.53），胸痛为1.46（1.36-1.57）。女性在1年内接受冠状动脉血运重建的可能性低于男性：心肌梗死的校正比值比（和95%CO）为0.65（0.57-0.73），不稳定型心绞痛为0.39（0.35-0-44），稳定型心绞痛为0.35（0.29-0-42），胸痛为0.32（0.27-0.37）。女性对急性心肌梗死患者的1年死亡率没有影响;与不稳定型心绞痛、稳定型心绞痛和胸痛患者的1年死亡率降低相关：校正后的风险比（和95% CI）0.60（0.46-0.78）、0.60（0.46-0.78）和0.74（0.63-0-87）。判读：与男性相比，因冠状动脉综合征而到急诊科就诊的女性入住急诊医院和接受冠状动脉治疗的可能性更小。血运重建手术。这些差异并没有转化为女性1年死亡率方面的更差结果。
Background: Previous studies examining sex-related differences in the treatment of coronary artery disease have focused on patients in hospital. We sought to examine sex-related differences at an earlier point in care-presentation to the emergency department.Methods: We collected data on ambulatory care and hospital admissions for 54 134 patients (44% women) who presented to an emergency department in Alberta between July 1998 and March 2001 because of acute myocardial infarction, unstable angina, stable angina or chest pain. We used logistic regression and Cox regression analyses to determine sex-specific associations between the likelihood of discharge from the emergency department or coronary revascularization within 1 year and 1-year mortality after adjusting for age, comorbidities and socioeconomic factors.Results: Following the emergency department visit, 91.3% of patients with acute myocardial infarction, 87.4% of those-with unstable angina, 40.7% of those with stable angina and 19.8% of those with chest pain were admitted to hospital. Women were more likely than men to be discharged from the emergency department: adjusted odds ratio (and 95% confidence interval [Cl]) 2.25 (1.75-2.90) for acute myocardial infarction, 1.71 (1.45-2.01) for unstable angina, 1.33 (1.15-1.53) for stable angina and 1.46 (1.36-1.57) for chest pain. Women were less likely than men to undergo coronary revascularization within 1 year: adjusted odds ratio (and 95% CO 0.65 (0.57-0.73) for myocardial infarction, 0.39 (0.35-0-44) for unstable angina, 0.35 (0.29-0-42) for stable angina and 0.32 (0.27-0.37) for chest pain. Female sex had no impact on 1-year mortality among patients with acute myocardial infarction; it was associated with a decreased 1-year mortality among patients with unstable angina, stable angina and chest pain: adjusted hazard ratio (and 95% Cl) 0.60 (0.46-0.78), 0.60 (0.46-0.78) and 0.74 (0.63-0-87) respectively.Interpretation: Women presenting to the emergency department with coronary syndromes are less likely than men to be admitted to an acute care hospital and to receive coronary revascularization procedures. These differences do not translate into worse outcomes for women in terms of 1 -year mortality.