Srinivas V S, Garg Sangeeta, Negassa Abdissa, Bang Ji Yon, Monrad E Scott
Department of Medicine, Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
J Invasive Cardiol. 2007 Jun;19(6):265-8.
Although sex-related differences in early outcomes have been observed in young women following acute myocardial infarction (AMI) and coronary bypass surgery, evidence for similar differences following percutaneous coronary intervention (PCI) is lacking.
Using the 1999 to 2002 New York State PCI reporting system, we identified 11,162 men and 2,561 women aged 50 years or younger undergoing a first PCI procedure. In-hospital outcomes were compared by gender after multivariable adjustment for baseline, clinical and procedural characteristics.
Young women undergoing an initial PCI procedure were more likely to belong to racial or ethnic minorities and exhibit more comorbidities than young men. However, they had better ejection fraction (52.9% +/- 11.3 vs. 51.9 +/- 11; p = 0.0002) and presented more often with single-vessel disease (75% vs. 67%; p < 0.0001). Despite women receiving glycoprotein IIb/IIIa inhibitors (58.6% vs. 65.1%; p < 0.0001) and stents (92.5% vs. 94.9%; p < 0.0001) less often, procedural success was achieved equally (97% vs. 96%). Young women experienced higher rates of in-hospital mortality (0.70% vs. 0.22%; p < 0.0001), and vascular damage (0.82% vs. 0.24%; p < 0.0001) compared to men. In multivariable analysis, female sex independently predicted in-hospital mortality (OR 4.0, 95% CI: 1.9 to 8.1) after adjustment for urgency of PCI, clinical and procedural characteristics.
A gender-based difference in early survival exists in young women undergoing a first PCI procedure. Further investigation into the mechanism of this higher risk is warranted.
尽管在年轻女性急性心肌梗死（AMI）和冠状动脉搭桥手术后的早期预后中观察到了性别差异，但经皮冠状动脉介入治疗（PCI）后类似差异的证据仍然缺乏。
利用1999年至2002年纽约州PCI报告系统，我们确定了11162名年龄在50岁及以下接受首次PCI手术的男性和2561名女性。在对基线、临床和手术特征进行多变量调整后，按性别比较住院结局。
与年轻男性相比，接受初次PCI手术的年轻女性更有可能属于少数种族或族裔，且合并症更多。然而，她们的射血分数更好（52.9%±11.3对51.9±11；p = 0.0002），且单支血管病变更为常见（75%对67%；p < 0.0001）。尽管女性接受糖蛋白IIb/IIIa抑制剂（58.6%对65.1%；p < 0.0001）和支架（92.5%对94.9%；p < 0.0001）的频率较低，但手术成功率相当（97%对96%）。与男性相比，年轻女性的住院死亡率（0.70%对0.22%；p < 0.0001）和血管损伤率（0.82%对0.24%；p < 0.0001）更高。在多变量分析中，在调整PCI的紧急程度、临床和手术特征后，女性性别独立预测住院死亡率（OR 4.0，95% CI：1.9至8.1）。
接受首次PCI手术的年轻女性在早期生存方面存在基于性别的差异。有必要进一步研究这种高风险的机制。
