期刊
CIRCULATION-CARDIOVASCULAR INTERVENTIONS
卷 11, 期 1, 页码 -出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCINTERVENTIONS.117.005735
关键词
comorbidity; hospitalization; hospital mortality; length of stay; risk factors
资金
- Empire Clinical Research Investigator Program
- National Institutes of Health/National Center for Advancing Translational Science Einstein-Montefiore CTSA [UL1TR001073]
- AHA Mentored Clinical and Population Award
- Amarin
- Amgen
- AstraZeneca
- Bristol-Myers Squibb
- Chiesi
- Eisai
- Ethicon
- Forest Laboratories
- Ironwood
- Ischemix
- Lilly
- Medtronic
- Pfizer
- Roche
- Sanofi Aventis
- Medicines Company
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.
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