Contemporary Sex-Based Differences by Age in Presenting Characteristics, Use of an Early Invasive Strategy, and Inhospital Mortality in Patients With Non-ST-Segment-Elevation Myocardial Infarction in the United States
Contemporary Sex-Based Differences by Age in Presenting Characteristics, Use of an Early Invasive Strategy, and Inhospital Mortality in Patients With Non-ST-Segment-Elevation Myocardial Infarction in the United States
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DOI：
10.1161/circinterventions.117.005735
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发表时间：
2018-01-01
影响因子：
5.6
通讯作者：
Bhatt, Deepak L.
中科院分区：
文献类型：
--
作者：
Gupta, Tanush;Kolte, Dhaval;Bhatt, Deepak L.
背景-先前的研究报告了女性非ST段抬高心肌梗死患者的住院死亡率高于男性。这是因为与男性相比，基线风险状况更差，还是由于治疗上的性别差异，目前还不完全清楚。方法和结果-我们查询了2003至2014年全国住院患者样本数据库，以确定主要诊断为非ST段抬高心肌梗死的18岁患者的所有住院情况。使用复杂样本多变量Logistic回归模型来检验使用早期侵入性策略的性别差异和住院死亡率。在4765739例非ST段抬高心肌梗死患者中，2026285例(42.5%)为女性。女性平均比男性大6岁，并且有更高的合并症负担。女性不太可能接受早期侵入性策略的治疗(29.4%对39.2%；调整后的优势比为0.92；95%的可信区间为0.91-0.94)。女性的住院粗死亡率高于男性(4.7%对3.9%；未调整优势比1.22；95%可信区间1.20-1.25)。在调整了年龄(调整后的优势比，0.96；95%可信区间，0.94-0.98)以及另外的合并症、其他人口结构和医院特征后，女性住院死亡率降低了10%(调整后的优势比，0.90；95%可信区间，0.89-0.92)。对早期侵入性策略使用的差异进行进一步调整并没有改变女性与较低风险调整后住院死亡率之间的关联。结论--尽管与男性相比，女性较少接受早期侵入性策略的治疗，但较少使用早期侵入性策略并不是导致女性住院粗死亡率较高的原因，这完全可以由年龄较大和较高的共病负担来解释。
Background-Prior studies have reported higher inhospital mortality in women versus men with non-ST-segment-elevation myocardial infarction. Whether this is because of worse baseline risk profile compared with men or sex-based disparities in treatment is not completely understood.Methods and Results-We queried the 2003 to 2014 National Inpatient Sample databases to identify all hospitalizations in patients aged 18 years with the principal diagnosis of non-ST-segment-elevation myocardial infarction. Complex samples multivariable logistic regression models were used to examine sex differences in use of an early invasive strategy and inhospital mortality. Of 4765739 patients with non-ST-segment-elevation myocardial infarction, 2026285 (42.5%) were women. Women were on average 6 years older than men and had a higher comorbidity burden. Women were less likely to be treated with an early invasive strategy (29.4% versus 39.2%; adjusted odds ratio, 0.92; 95% confidence interval, 0.91-0.94). Women had higher crude inhospital mortality than men (4.7% versus 3.9%; unadjusted odds ratio, 1.22; 95% confidence interval, 1.20-1.25). After adjustment for age (adjusted odds ratio, 0.96; 95% confidence interval, 0.94-0.98) and additionally for comorbidities, other demographics, and hospital characteristics, women had 10% lower odds of inhospital mortality (adjusted odds ratio, 0.90; 95% confidence interval, 0.89-0.92). Further adjustment for differences in the use of an early invasive strategy did not change the association between female sex and lower risk-adjusted inhospital mortality.Conclusions-Although women were less likely to be treated with an early invasive strategy compared with men, the lower use of an early invasive strategy was not responsible for the higher crude inhospital mortality in women, which could be entirely explained by older age and higher comorbidity burden.