Pain Thomas E, Jones Daniel A, Rathod Krishnaraj S, Gallagher Sean M, Knight Charles J, Mathur Anthony, Rothman Martin T, Jain Ajay K, Wragg Andrew
Department of Cardiology, London Chest Hospital, Bart's Health NHS Trust, London, UK.
Coron Artery Dis. 2013 May;24(3):183-90. doi: 10.1097/MCA.0b013e32835d75f0.
Female sex has been associated with worse outcome after percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS). We assessed the influence of female sex on the long-term outcome of patients undergoing PCI for ACS. This included an unadjusted analysis and a fully-adjusted multivariate analysis including a propensity score.
This was an observational cohort study involving 7304 patients who had PCI for ACS [ST-elevation myocardial infarction (STEMI), non-ST elevation (NSTE) ACS] between October 2003 and September 2010. We analysed the effect of female sex on outcome.
The primary end point was all-cause mortality, which was obtained from the UK Office of National Statistics at a median follow-up of 3.2 years (IQR: 1.5-4.6). Women were significantly older and had higher rates of diabetes mellitus compared with men. Over long-term follow-up, mortality was significantly higher in women with ACS compared with men; as a whole [all ACS: odds ratio (OR) 1.351, P<0.001] or when analysed by ACS type (NSTE ACS: OR 1.260, P=0.009; STEMI: OR 1.625, P<0.001). However, after adjustment using multivariate analysis, female sex was not an independent predictor of mortality in any ACS group (all ACS: OR 0.978, P=0.772; NSTE ACS: OR 0.954, P=0.603; STEMI: OR 1.081, P=0.567). This observation remained after the incorporation of a propensity score into the multivariate analysis [OR 0.95, 95% confidence interval 0.82-1.10].
Women presenting with ACS were older and had more baseline comorbidities. Female sex, however, does not appear to be an independent risk factor for mortality in our cohort.
女性在急性冠状动脉综合征（ACS）行经皮冠状动脉介入治疗（PCI）后预后较差。我们评估了女性性别对ACS患者接受PCI后长期预后的影响。这包括未经调整的分析和包含倾向评分的完全调整多变量分析。
这是一项观察性队列研究，纳入了2003年10月至2010年9月期间因ACS[ST段抬高型心肌梗死（STEMI）、非ST段抬高型（NSTE）ACS]接受PCI的7304例患者。我们分析了女性性别对预后的影响。
主要终点为全因死亡率，数据来自英国国家统计局，中位随访时间为3.2年（四分位间距：1.5 - 4.6年）。与男性相比，女性年龄显著更大，糖尿病患病率更高。在长期随访中，ACS女性患者的死亡率显著高于男性；总体而言[所有ACS：比值比（OR）1.351，P<0.001]，或按ACS类型分析时（NSTE ACS：OR 1.260，P = 0.009；STEMI：OR 1.625，P<0.001）。然而，在使用多变量分析进行调整后，女性性别并非任何ACS组死亡率的独立预测因素（所有ACS：OR 0.978，P = 0.772；NSTE ACS：OR 0.954，P = 0.603；STEMI：OR 1.081，P = 0.567）。在多变量分析中纳入倾向评分后，这一观察结果仍然成立[OR 0.95，95%置信区间0.82 - 1.10]。
患有ACS的女性年龄更大，基线合并症更多。然而，在我们的队列中，女性性别似乎并非死亡率的独立危险因素。
