Mehilli J, Kastrati A, Dirschinger J, Bollwein H, Neumann F J, Schömig A
Deutsches Herzzentrum, Lazarettstr 36, 80636 Munich, Germany.
JAMA. 2000 Oct 11;284(14):1799-805. doi: 10.1001/jama.284.14.1799.
Women with coronary artery disease (CAD) are believed to have a higher risk for adverse outcomes than men after conventional coronary interventions. The increasing use of coronary stenting has improved the outcome of patients undergoing coronary interventions, but little is known about the nature of outcomes in men vs women after this procedure.
To examine whether there are sex-based differences in prognostic factors and in early and late outcomes among CAD patients undergoing coronary stent placement.
DESIGN, SETTING, AND PATIENTS: Inception cohort study, at 2 tertiary referral institutions in Germany. Consecutive series of 1001 women and 3263 men with symptomatic CAD who were treated with stenting between May 1992 and December 1998. Patients who underwent stenting in the setting of acute myocardial infarction were excluded.
The combined event rates of death and nonfatal myocardial infarction, assessed at 30 days and 1 year after stenting and compared by sex.
Compared with men, women undergoing coronary stenting were significantly older (mean age, 69 vs 63 years) and more likely to present with diabetes, arterial hypertension, or hypercholesterolemia. Women had less extensive CAD, a less frequent history of myocardial infarction and better preserved left ventricular function than men. Women presented an excess risk of death or nonfatal myocardial infarction only during the early period after stenting: the 30-day combined event rate of death or myocardial infarction was 3.1% in women and 1.8% in men (P =.02) and the multivariate-adjusted hazard ratio (HR) for women was 2.02 (95% confidence interval [CI], 1.27-3.19). At 1 year, the outcome was similar for both women and men (combined event rate for women, 6.0%, and for men, 5.8% (P =.77); multivariate-adjusted HR for women, 1.06 [95% CI, 0.75-1.48]). There was a sex difference in the prognostic value of baseline characteristics: the strongest prognostic factors were diabetes in women and age in men.
The results of this study indicate that 1-year outcomes of women with CAD undergoing coronary artery stenting are similar to those of men. Despite the similarity in outcomes, there are several sex-specific differences in baseline characteristics, clinical course after the intervention, and relative weight of prognostic factors. JAMA. 2000;284:1799-1805.
一般认为，患有冠状动脉疾病（CAD）的女性在接受传统冠状动脉介入治疗后出现不良后果的风险高于男性。冠状动脉支架置入术的使用日益增加，改善了接受冠状动脉介入治疗患者的预后，但对于接受该手术后男性和女性的预后性质知之甚少。
研究接受冠状动脉支架置入术的CAD患者在预后因素以及早期和晚期预后方面是否存在性别差异。
设计、地点和患者：在德国两家三级转诊机构进行的队列起始研究。1992年5月至1998年12月期间连续收治的1001例有症状CAD女性患者和3263例有症状CAD男性患者，均接受了支架置入治疗。排除在急性心肌梗死情况下接受支架置入的患者。
评估支架置入后30天和1年时死亡和非致命性心肌梗死的联合事件发生率，并按性别进行比较。
与男性相比，接受冠状动脉支架置入术的女性年龄显著更大（平均年龄69岁对63岁），更有可能患有糖尿病、动脉高血压或高胆固醇血症。与男性相比，女性的CAD病变范围较小，心肌梗死病史较少，左心室功能保留较好。女性仅在支架置入后的早期存在死亡或非致命性心肌梗死的额外风险：女性30天死亡或心肌梗死的联合事件发生率为3.1%，男性为1.8%（P = 0.02），女性的多变量调整风险比（HR）为2.02（95%置信区间[CI]，1.27 - 3.19）。在1年时，女性和男性的预后相似（女性联合事件发生率为6.0%，男性为5.8%（P = 0.77）；女性的多变量调整HR为1.06[95% CI，0.75 - 1.48]）。基线特征的预后价值存在性别差异：女性中最强的预后因素是糖尿病，男性中是年龄。
本研究结果表明，接受冠状动脉支架置入术的CAD女性患者1年的预后与男性相似。尽管预后相似，但在基线特征、干预后的临床过程以及预后因素的相对权重方面存在一些性别特异性差异。《美国医学会杂志》。2000年；284:1799 - 1805。
