Department of Medicine, Division of Cardiovascular Diseases, Stony Brook University Medical Center, Stony Brook, New York, USA.
Am J Cardiol. 2011 May 1;107(9):1319-23. doi: 10.1016/j.amjcard.2010.12.042. Epub 2011 Feb 23.
We aimed to determine whether gender and race are independently associated with in-hospital major adverse cardiac and cerebrovascular events (MACCE) and hospital length of stay in chronic dialysis patients undergoing percutaneous coronary intervention (PCI). Cardiovascular disease is the leading cause of mortality in patients with end-stage renal disease requiring dialysis. Whether gender or race independently influences the outcomes in patients undergoing PCI is not fully understood. The study population included 474 chronic dialysis patients who underwent PCI at 4 New York State teaching hospitals from January 1, 2004 to December 31, 2007. The primary end point of the study was the composite of in-hospital MACCE, defined as all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke. The secondary end points included in-hospital all-cause mortality and hospital length of stay. Of the 474 chronic dialysis patients, 172 (36.3%) were women. The women undergoing PCI were more likely to be black or Hispanic and had a greater left ventricular ejection fraction. The women had significantly greater rates of in-hospital MACCE (5.8% vs 1.7%, p=0.013) and mortality (4.7% vs 0.7%, p=0.006). No significant difference in the MACCE rates was found between the black and white patients (4.9% vs 2.2%, respectively, p=0.125), although black patients showed a trend toward greater in-hospital mortality (4.1% vs 1.2%, p=0.069). After adjustment for the baseline clinical and procedural characteristics, female gender was an independent predictor of MACCE (odds ratio 7.41, 95% confidence interval 1.81 to 30.27) and all-cause mortality (odds ratio 13.23, 95% confidence interval 1.55 to 113.25), but race was not. No significant difference in the hospital length of stay was observed by either gender or race. In conclusion, in this study, female gender was independently associated with a greater risk of MACCE and all-cause mortality in dialysis-dependent patients undergoing PCI. Although being a black woman was an independent predictor of mortality, race per se was not an independent predictor of in-hospital mortality.
我们旨在确定性别和种族是否与接受经皮冠状动脉介入治疗 (PCI) 的慢性透析患者的院内主要不良心脑血管事件 (MACCE) 和住院时间长短独立相关。心血管疾病是需要透析的终末期肾病患者死亡的主要原因。在接受 PCI 的患者中，性别或种族是否独立影响结局尚不完全清楚。研究人群包括 2004 年 1 月 1 日至 2007 年 12 月 31 日在纽约州 4 家教学医院接受 PCI 的 474 例慢性透析患者。该研究的主要终点是院内 MACCE 的复合终点，定义为全因死亡率、非致死性心肌梗死和非致死性卒中。次要终点包括院内全因死亡率和住院时间。在 474 例慢性透析患者中，172 例 (36.3%)为女性。接受 PCI 的女性更可能为黑人和/或西班牙裔，且左心室射血分数更高。女性院内 MACCE 发生率显著更高 (5.8% vs. 1.7%，p=0.013)，死亡率也更高 (4.7% vs. 0.7%，p=0.006)。黑人和白人患者的 MACCE 发生率无显著差异 (分别为 4.9%和 2.2%，p=0.125)，但黑人患者院内死亡率有升高趋势 (4.1% vs. 1.2%，p=0.069)。在校正基线临床和手术特征后，女性性别是 MACCE (比值比 7.41，95%置信区间 1.81 至 30.27) 和全因死亡率 (比值比 13.23，95%置信区间 1.55 至 113.25) 的独立预测因素，但种族不是。性别或种族均与住院时间长短无显著相关性。总之，在本研究中，女性性别与依赖透析接受 PCI 的患者 MACCE 和全因死亡率增加独立相关。尽管黑人女性是死亡率的独立预测因素，但种族本身并不是院内死亡率的独立预测因素。
