Shrestha Rajiv, Gami Sandeep, Xu Jing, Xie Du-Jiang, Liu Zhi-Zhong, Xu Tian, Ye Fei, Din Shi-Qing, Qian Xue-Song, Yang Song, Liu Yue-Qiang, Li Feng, Zhang Ai-Ping, Chen Shao-Liang
Nanjing Medical University, Nanjing.
Patient Prefer Adherence. 2013 Jul 8;7:667-74. doi: 10.2147/PPA.S45073. Print 2013.
Previous studies have reported a discrepancy in baseline characteristics and outcomes after percutaneous coronary intervention between men and women. However, this finding has never been verified in the Chinese population. The present study analyzed two-year clinical outcomes after placement of coronary drug-eluting stents in Chinese men and women.
From January 2005 to December 2010, a total of 3804 Chinese patients (2776 men, 1028 women) who underwent drug-eluting stent implantation were studied prospectively. The primary endpoint was the composite major adverse cardiac event (MACE) rate, including myocardial infarction, cardiac death, and target vessel revascularization at two years. Stent thrombosis served as the safety endpoint. Propensity score matching was used to compare the adjusted MACE rate between the two groups.
At two-year follow-up, unadjusted rates of myocardial infarction, non-ST segment elevation myocardial infarction, target vessel revascularization, and MACE were significantly different between men (6.84%, 4.6%, 13.1%, and 21.7%, respectively) and women (3.8% [P = 0.001], 2.0% [P < 0.001] 10.3% [P = 0.025], and 16.3% [P < 0.001], respectively). After propensity score matching, there were no significant differences in composite MACE and individual endpoints at two years between the genders.
Despite all the unfavorable risk factor clustering in women and complex coronary disease in men, the two-year clinical outcomes after coronary stent placement were comparable between Chinese women and men.
既往研究报道了经皮冠状动脉介入治疗后男性和女性在基线特征及预后方面存在差异。然而，这一发现从未在中国人群中得到验证。本研究分析了中国男性和女性冠状动脉药物洗脱支架置入术后的两年临床预后。
2005年1月至2010年12月，对3804例接受药物洗脱支架植入的中国患者（2776例男性，1028例女性）进行前瞻性研究。主要终点是复合主要不良心脏事件（MACE）发生率，包括两年时的心肌梗死、心源性死亡和靶血管血运重建。支架血栓形成作为安全性终点。采用倾向评分匹配法比较两组调整后的MACE发生率。
在两年随访时，男性（分别为6.84%、4.6%、13.1%和21.7%）和女性（分别为3.8%[P = 0.001]、2.0%[P < 0.001]、10.3%[P = 0.025]和16.3%[P < 0.001]）的心肌梗死、非ST段抬高型心肌梗死、靶血管血运重建和MACE的未调整发生率存在显著差异。倾向评分匹配后，两年时两性之间的复合MACE及各个终点均无显著差异。
尽管女性存在所有不利的危险因素聚集且男性存在复杂的冠状动脉疾病，但中国女性和男性冠状动脉支架置入术后的两年临床预后相当。
