在接受依维莫司洗脱支架的直接经皮冠状动脉介入治疗的急性 ST 段抬高型心肌梗死患者中，短期临床结局无性别差异：上海急性冠状动脉事件（SACE）登记研究的报告。

Absence of gender disparity in short-term clinical outcomes in patients with acute ST-segment elevation myocardial infarction undergoing sirolimus-eluting stent based primary coronary intervention: a report from Shanghai Acute Coronary Event (SACE) Registry.

机构信息

Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.

出版信息

Chin Med J (Engl). 2010 Apr 5;123(7):782-8.

PMID:20497664

Abstract

BACKGROUND

Randomized, controlled trials have demonstrated the superiority of sirolimus-eluting stent (SES) implantation during primary percutaneous coronary intervention (PCI), as opposed to bare-metal stents, in patients with ST-elevation myocardial infarction (STEMI). This study aimed to test the hypothesis that clinical benefits of SES treatment were independent of gender in this setting.

METHODS

A total of 2042 patients with STEMI undergoing SES-based primary PCI were prospectively enrolled into Shanghai Acute Coronary Event (SACE) registry (1574 men and 468 women). Baseline demographics, angiographic and PCI features, and in-hospital and 30-day major adverse cardiac events (MACE) were analyzed as a function of gender.

RESULTS

Compared with men, women were older and more frequently had hypertension, diabetes, and hypercholesterolemia. Use of platelet glycoprotein IIb/IIIa receptor inhibitor (GPI, 65.5% vs. 62.2%, P = 0.10) and procedural success rate (95.0% vs. 94.2%, P = 0.52) were similar in both genders. In-hospital death and MACE occurred in 3.8% and 7.6%, and 4.5% and 8.1% in the male and female patients, respectively (all P > 0.05). At 30-day follow-up, survival (94.3% vs. 93.8%, P = 0.66) and MACE-free survival (90.2% vs. 89.3%, P = 0.52) did not significantly differ between men and women. After adjustment for differences in patient demographics, angiographic and procedural features, there were no significant difference in either in-hospital (OR = 0.77, 95%CI of 0.48 to 1.22, P = 0.30) or 30-day mortality (OR = 1.28, 95%CI of 0.73 to 2.23, P = 0.38) between women and men.

CONCLUSION

Despite more advanced age and clustering of risk factors in women, female patients with STEMI treated by SES-based primary PCI had similar in-hospital and short-term clinical outcomes as their male counterparts.

摘要

背景

随机对照试验已经证明，在 ST 段抬高型心肌梗死（STEMI）患者中，与裸金属支架相比，药物洗脱支架（SES）在经皮冠状动脉介入治疗（PCI）中的优越性。本研究旨在检验以下假设，即在此背景下，SES 治疗的临床益处与性别无关。

方法

共前瞻性纳入 2042 例接受 SES 基础 PCI 的 STEMI 患者入组上海急性冠脉事件（SACE）登记研究（男性 1574 例，女性 468 例）。分析基线人口统计学、血管造影和 PCI 特征以及院内和 30 天主要不良心脏事件（MACE）与性别之间的关系。

结果

与男性相比，女性年龄较大，更常患有高血压、糖尿病和高胆固醇血症。血小板糖蛋白 IIb/IIIa 受体抑制剂（GPI）的使用率（65.5% vs. 62.2%，P = 0.10）和手术成功率（95.0% vs. 94.2%，P = 0.52）在两性之间相似。院内死亡和 MACE 发生率分别为 3.8%和 7.6%，男性和女性患者分别为 4.5%和 8.1%（均 P > 0.05）。30 天随访时，男性和女性患者的生存率（94.3% vs. 93.8%，P = 0.66）和 MACE 无事件生存率（90.2% vs. 89.3%，P = 0.52）无显著差异。调整患者人口统计学、血管造影和手术特征的差异后，院内（OR = 0.77，95%CI 为 0.48 至 1.22，P = 0.30）或 30 天死亡率（OR = 1.28，95%CI 为 0.73 至 2.23，P = 0.38）在女性和男性之间均无显著差异。