| Summary: | 碩士 === 慈濟大學 === 公共衛生研究所 === 97 === Based on Department of Health ‘health statistics information show, heart disease has been the highest in the top three leading causes of death among Taiwanese for nearly a decade, and coronary heart disease be the majority in the heart disease, one of the most serious is the acute myocardial infarction
(AMI).There are ten thousands to twenty thousands people to sicken with acute myocardial infarction every year in Taiwan. Of these about one thousand to two thousands will dead.
At present, several studies suggest that women with AMI use less medical utilization, such as less thrombolytic therapy,coronary angiography and invasive treatment also fewer than men. In addition, women with AMI has higher short-term fatality compared to men, even among patients undergoing PTCA , mortality was higher in women after adjusting risk factor such as age. But there is unclear whether the percent of medical treatment will effect patients’short-term fatality rate.
Therefore, the study use the Longitudinal Health Insurance Database 2000 (LHID2000) from National Health Insurance Research Database (NHIRD) in 1996 to 2007 , screening of the new occurrence of myocardial infarction cases in 2000 to 2006. Logistic Regression analysis was used to explore patients’
therapy of inpatient and outpatient and length of hospitalization affect the 30-day mortality rate of reasons, research on whether there is any difference in medical use and the prognosis outcome between the sexes.
Results suggested that Taiwanese’AMI male patients have 2.28-fold risk of AMI compared with women. In 532 AMI patients, women were older than men,had more comorbidities , such as diabetes,heart failure. Women received less antiplatelet(93% vs. 85%, p=0.010),thrombolytic agent(13% vs. 6%, p=0.013), and less invasive treatment, including coronary angiography(59% vs.36%, p<0.001) and PCI (45% vs.25%, p<0.001). Women has longer length of hospitalization , daily medical expenses also higher than men. Although incidence rate is significantly higher among men compare with women, but there is no sex differences in 30-day mortality rates after AMI (17% vs. 17%). After adjusting the age, comorbidities and medical utilization ,there is sex differences in 30-day mortality rates ,women has better prognosis than men, them have 0.39-fold risk compared with men.There is no mortality rates difference in the undergoing PCI patients between sexes, and in don’t received PCI patients,men has poor prognosisthan women, women has 0.42-fold risk compared with men.
The AMI patients in Taiwan ,the reasons of men received more medical treatment were women were older,had more comorbidities affect the proportion of treatment. The explanation of effecting medical utilization and 30-day mortality rates be roughly the same as with the literature, but after adjusting in all patients and no received PCI patients, men have higher mortality than women, whether in Taiwan or abroad literature , it’s rarely result. Maybe associated with study limitations and the rules of determine, be
need to further research confirmed.
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