目的:本研究旨在验证急性冠状动脉综合征(ACS)患者使用冠状动脉介入治疗的性别差异.方法:对墨尔本一家大型城市医院2009-2012年住院的2096例ACS患者数据库进行了回顾性分析.ACS包括不稳定型心绞痛(UA)、ST段抬高型心肌梗死(STEMI)和非ST段抬高型心肌梗死(NSTEMI).结果:患者的平均年龄为64.3岁,其中624例(30%)为女性.一半病例被诊断为NSTEMI,23%的病例为STEMI,25%的病例为UA.与男性患者相比,女性患者入院时年龄较大,诊断为STEMI的比例较低,吸烟率较低;在严重共存病或使用冠状动脉造影方面,未观察到性别差异.诊断为STEMI的病例中,女性患者接受血管成形术支架的比例比男性患者低39%(调整OR=0.61,95%可信区间为0.39~0.96);接受冠状动脉旁路移植术的比例比男性患者低66%(调整OR=0.34,95%可信区间为0.13~0.93).诊断为NSTEMI的病例中,女性患者接受冠状动脉旁路移植术的比例比男性患者低44%(调整OR=0.56,95%可信区间为0.37~0.83).35~49岁的年轻病例中,女性患者接受血管成形术支架的比例低于男性患者;50岁以上的年长病例中,女性患者接受冠状动脉旁路移植术的比例低于男性患者.结论:坚持以指南为基础的治疗,将有助于确保知识从指南到临床实践的转换.在进一步的研究中,调查临床表现,根据性别对AC S进行无创性检查和医学干预,也许可以更深入地解释冠状动脉介入治疗的性别差异.%Objective: The study aimed to examine gender differences in the use of coronary interventions amongst patients with acute coronary syndrome (ACS) admitted to a major metropolitan hospital in Melbourne during the period 2009–2012. Methods: We undertook a retrospective analysis of a hospital database of 2096 ACS patients. ACS included unstable angina (UA), ST-segment-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Results: The mean age of the patients was 64.3 years and 624 (30%) were women. Half of them were diagnosed as NSTEMI, 23% as STEMI and 25% as UA. Compared to men, women were older at admission, less likely to be diagnosed with STEMI and less likely to smoke. No gender difference was observed for severe co-morbidities or use of coronary angiography. Women diagnosed with STEMI were 39% less likely to receive an angioplasty stent (adjusted odds ratio 0.61, 95% conifdence intervals 0.39–0.96) and 66% less likely to receive grafts (adjustedOR 0.34, 95% CIs 0.13–0.93). Women diagnosed with NSTEMI were 44% less likely to receive grafts (adjustedOR 0.56, 95% CIs 0.37–0.83). Younger women aged 35–49 years were less likely to receive an angioplasty stent, and older women >50 years were less likely to receive grafts. Conclusion: Adherence to guideline based treatment will help to ensure knowledge translation from guideline to practice. Further research investigating symptom presentation, use of non-invasive tests and medical management of ACS by gender may further explain gender difference for coronary interventions.
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