性别对首次表现为缺血性心脏病的患者接受 mTOR 抑制剂药物洗脱支架植入后的临床结局的影响。

Impact of gender on clinical outcomes after mTOR-inhibitor drug-eluting stent implantation in patients with first manifestation of ischaemic heart disease.

机构信息

Istituto di Cardiologia, Catholic University of Sacred Heart, Rome, Italy.

出版信息

Eur J Prev Cardiol. 2012 Oct;19(5):914-26. doi: 10.1177/1741826711420001. Epub 2011 Aug 12.

DOI:10.1177/1741826711420001

PMID:21840968

Abstract

BACKGROUND

Women have a worse outcome than men after percutaneous coronary intervention (PCI). However, in the drug-eluting stent (DES) era, limited data are available about the impact of gender-related differences on clinical outcome. Furthermore, many series have also included patients previously treated by coronary-artery bypass grafts or PCI, which may bias the evaluation of DES-related clinical events at follow up. We aimed to assess the impact of gender on clinical outcomes in a consecutive series of patients at first manifestation of coronary artery disease (CAD) undergoing PCI with mTOR-inhibitor DES.

METHODS AND RESULTS

A total of 138 consecutive patients (age 64 ± 13 years, female gender 29%) undergoing successful mTOR-inhibitor DES implantation [sirolimus-eluting stent (SES); zotarolimus-eluting stent (ZES); and everolimus-eluting stent (EES)] for the treatment of stable chronic angina or an acute coronary syndrome, as their first clinical manifestation of CAD, were prospectively enrolled between February 2008 and May 2009. Major adverse cardiac events (MACE), defined as a combination of cardiac death, myocardial infarction (MI), and clinically driven target lesion revascularization (TVR) at 12-month follow up, constituted the endpoint of the study. Fifty-one (37%) patients received SES; 46 (33%) patients received ZES; and 41 (30%) patients received EES. At follow up, 21 (15%) patients experienced a MACE. Three (2%) patients had cardiac death, five (4%) had MI, while 13 (9%) patients underwent clinically driven TVR. MACE occurred more frequently in females than males [10 (25%) vs. 11 (11%), p = 0.05]. At Cox regression analysis, the only independent predictors of MACE were female gender and implantation of more than one stent [hazard ratio (HR) 3.70, 95% confidence interval (CI) 1.46-9.36, p = 0.006; HR 1.26, 95% CI 0.99-2.74, p = 0.01, respectively].

CONCLUSIONS

In conclusion, our finding suggests that women may have a worse outcome as compared with men after mTOR-inhibitor DES implantation.

摘要

背景

经皮冠状动脉介入治疗（PCI）后，女性的预后较男性差。然而，在药物洗脱支架（DES）时代，关于性别差异对临床结局影响的资料有限。此外，许多研究还包括先前接受过冠状动脉旁路移植术或 PCI 的患者，这可能会影响对 DES 相关临床事件的随访评估。我们旨在评估在首次出现冠状动脉疾病（CAD）的连续患者系列中，性别对接受 mTOR 抑制剂 DES 治疗的 PCI 患者临床结局的影响。

方法和结果

总共纳入 138 例连续患者（年龄 64±13 岁，女性占 29%），因稳定型慢性心绞痛或急性冠状动脉综合征而首次出现 CAD，于 2008 年 2 月至 2009 年 5 月期间接受成功的 mTOR 抑制剂 DES 植入术（西罗莫司洗脱支架[SES]；佐他莫司洗脱支架[ZES]；依维莫司洗脱支架[EES]）治疗。主要不良心脏事件（MACE）定义为 12 个月随访时的心脏死亡、心肌梗死（MI）和临床驱动的靶病变血运重建（TVR）的组合，为该研究的终点。51 例（37%）患者接受 SES；46 例（33%）患者接受 ZES；41 例（30%）患者接受 EES。随访时，21 例（15%）患者发生 MACE。3 例（2%）患者发生心脏死亡，5 例（4%）患者发生 MI，13 例（9%）患者接受了临床驱动的 TVR。女性的 MACE 发生率高于男性[10（25%）vs. 11（11%），p=0.05]。在 Cox 回归分析中，MACE 的唯一独立预测因子为女性性别和植入超过一个支架[风险比（HR）3.70，95%置信区间（CI）1.46-9.36，p=0.006；HR 1.26，95% CI 0.99-2.74，p=0.01]。