在接受直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者中，依维莫司洗脱支架对长期结局的性别特异性获益：来自多中心评价单次大剂量替罗非班与阿昔单抗联合依维莫司洗脱支架或裸金属支架治疗急性心肌梗死研究试验的结果。

Sex-specific benefits of sirolimus-eluting stent on long-term outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: insights from the Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study trial.

机构信息

Department of Interventional Cardiology, Istituto Clinico Humanitas, IRCCS, Rozzano, Milan, Italy.

出版信息

Am Heart J. 2012 Jan;163(1):104-11. doi: 10.1016/j.ahj.2011.09.026.

DOI:10.1016/j.ahj.2011.09.026

PMID:22172443

Abstract

OBJECTIVES

We assessed the relation between female sex and sirolimus-eluting stent (SES) use on long-term outcomes in acute myocardial infarction.

BACKGROUND

There are no data on sex-specific differences in long-term benefit of SES use compared with bare-metal stent (BMS) use among patients undergoing primary percutaneous coronary interventions.

METHODS

We performed a post hoc analysis of the MULTISTRATEGY trial. Hazard ratios (HRs) of events with 95% CI for sex and stent type were computed using Cox proportional regression with adjustment for confounders.

RESULTS

A total of 744 patients, 64 years old (55-73 years old), 179 (24.1%) women, were enrolled. After a follow-up of 1,080 days, SES use was associated with a significant reduction of major adverse cardiovascular events, that is, the composite of all-cause death, reinfarction, or clinically driven target vessel revascularization (TVR) (13.9% vs 23.6%, adjusted HR 0.62, 95% CI 0.41-0.94, P = .026) and of TVR (6.1% vs 15.1%, adjusted HR 0.35, 95% CI 0.19-0.63, P < .001) in men. Conversely, SES use was not associated to a better outcome among women (major adverse cardiovascular events 21.9% in SES vs 18.2% in the BMS group, adjusted HR 1.27, 95% CI 0.53-3.02, P = .59; TVR 6.6% vs 9.1%, adjusted HR 0.62, 95% CI 0.17-2.21, P = .46).

CONCLUSIONS

In this analysis, the clinical benefit of SES use, over BMS, at 3-year follow-up was restricted to men and was not observed among women.

摘要

目的

我们评估了女性性别与西罗莫司洗脱支架（SES）使用在急性心肌梗死患者长期预后中的关系。

背景

在接受直接经皮冠状动脉介入治疗的患者中，关于 SES 使用与裸金属支架（BMS）使用相比的长期获益，尚没有关于性别特异性差异的数据。

方法

我们对 MULTISTRATEGY 试验进行了事后分析。使用 Cox 比例风险回归，在调整混杂因素后，计算事件的风险比（HR）及其 95%置信区间（CI），并对性别和支架类型进行分析。

结果

共纳入 744 例患者，年龄 64 岁（55-73 岁），其中 179 例（24.1%）为女性。随访 1080 天后，SES 使用与主要不良心血管事件（即全因死亡、再梗死或临床驱动的靶血管血运重建（TVR））显著减少相关（13.9% vs. 23.6%，调整 HR 0.62，95%CI 0.41-0.94，P =.026）和 TVR（6.1% vs. 15.1%，调整 HR 0.35，95%CI 0.19-0.63，P <.001）显著减少相关，这在男性中是如此。相反，SES 使用与女性患者的更好结局无关（SES 组的主要不良心血管事件发生率为 21.9%，BMS 组为 18.2%，调整 HR 1.27，95%CI 0.53-3.02，P =.59；TVR 发生率为 6.6% vs. 9.1%，调整 HR 0.62，95%CI 0.17-2.21，P =.46）。