Trabattoni Daniela, Fabbiocchi Franco, Galli Stefano, Montorsi Piero, Lualdi Alessandro, Grancini Luca, Ravagnani Paolo, Bartorelli Antonio L
Department of Cardiovascular Sciences, The Centro Cardiologico Fondazione 'Monzino' IRCCS, University of Milan, Italy.
Coron Artery Dis. 2011;22(6):442-6. doi: 10.1097/MCA.0b013e3283475056.
Coronary stenting in women has been associated with worse results in terms of morbidity, mortality, and restenosis rate in the bare-metal stent era, possibly due to higher risk profile and smaller coronary vessels. Although drug-eluting stents have equalized clinical results, no data are available on long-term outcomes between sexes.
To evaluate the role of sex in acute, mid-term, and long-term clinical outcome after sirolimus-eluting stent (SES) implantation.
We retrospectively evaluated 1186 patients, 970 (81.8%) male and 216 (18.2%) female, treated with SES implantation between April 2002 and December 2005.
Women were older (P=0.049), more likely to have hypertension (43.5 vs. 33.7%, P=0.006), single-vessel disease (63.9 vs. 42.5%, P=0.03), and unstable angina (16.6% vs. 9.2%, P=0.001) and more frequently received small (≤ 2.75 mm) vessel stenting (39.3 vs. 28.2%, P=0.001). The two groups were similar for lesion and procedural characteristics. Overall, the stent thrombosis rate was 0.4% (0.5% in women vs. 0.3% in men, P=not significant). At 6-month follow-up, no significant difference in major adverse cardiac event was observed. Long-term follow-up (median time 33.2 months), available in 180 (83.3%) women and 720 (75%) men, showed higher angina recurrence rate (17.7 vs. 11%, P=0.013), percutaneous coronary re-intervention (16.1 vs. 8.7%, P=0.001) and target vessel revascularization (3.9 vs. 0.9%, P=0.001) in women compared with men. Late stent thrombosis, need for coronary artery bypass grafting, and mortality were similar in both groups.
No sex difference was observed in acute and 6-month outcome after SES implantation despite older age, more unstable clinical presentation, and more frequent small vessel stenting in women. However, long-term clinical follow-up (up to 5 years) in women showed higher symptom recurrence and target vessel revascularization rate but no difference in overall major adverse cardiac events.
在裸金属支架时代，女性冠状动脉支架置入术在发病率、死亡率和再狭窄率方面的结果较差，这可能是由于女性具有更高的风险特征和更细小的冠状动脉血管。尽管药物洗脱支架使临床结果趋于均衡，但尚无关于两性长期预后的数据。
评估性别在西罗莫司洗脱支架（SES）植入术后急性、中期和长期临床结局中的作用。
我们回顾性评估了2002年4月至2005年12月期间接受SES植入术的1186例患者，其中男性970例（81.8%），女性216例（18.2%）。
女性年龄更大（P = 0.049），更易患高血压（43.5%对33.7%，P = 0.006）、单支血管病变（63.9%对42.5%，P = 0.03）和不稳定型心绞痛（16.6%对9.2%，P = 0.001），并且更频繁地接受小（≤2.75 mm）血管支架置入术（39.3%对28.2%，P = 0.001）。两组在病变和手术特征方面相似。总体而言，支架血栓形成率为0.4%（女性为0.5%，男性为0.3%，P无统计学意义）。在6个月随访时，未观察到主要不良心脏事件有显著差异。180例（83.3%）女性和720例（75%）男性有长期随访数据（中位时间33.2个月），结果显示女性心绞痛复发率（17.7%对11%，P = 0.013）、经皮冠状动脉再次干预率（16.1%对8.7%，P = 0.001）和靶血管血运重建率（3.9%对0.9%，P = 0.001）均高于男性。两组的晚期支架血栓形成、冠状动脉旁路移植术需求和死亡率相似。
尽管女性年龄更大、临床表现更不稳定且更频繁地接受小血管支架置入术，但在SES植入术后的急性和6个月结局中未观察到性别差异。然而，女性的长期临床随访（长达5年）显示症状复发率和靶血管血运重建率更高，但总体主要不良心脏事件无差异。
