Deutsches Herzzentrum München, Munich, Germany.
Am Heart J. 2013 Sep;166(3):534-40. doi: 10.1016/j.ahj.2013.07.006. Epub 2013 Aug 6.
Factors underlying the increased risk of bleeding after percutaneous coronary intervention (PCI) in women compared with men remain incompletely understood.
The study included 3,351 women and 3,351 men matched for age, body mass index, and type of antithrombotic therapy. Bleeding within the 30 days after PCI was defined using the Bleeding Academic Research Consortium criteria. The main outcome was 1-year mortality.
Bleeding occurred in 518 women and 354 men (15.5% vs 10.6%, odds ratio [OR] 1.55, 95% CI 1.34-1.79, P < .001). Severe (Bleeding Academic Research Consortium class ≥2) bleeds (9.4% vs 6.5%, P < .001) and access site bleeds (10.1% vs 5.4%, P < .001) were more common in women. After adjustment, female sex remained an independent correlate of any bleeding (adjusted OR 1.61 [1.35-1.92], P < .001) and access site (adjusted OR 2.00 [1.59-2.50], P < .001) but not of nonaccess site (adjusted OR 1.18 [0.91-1.54], P = .205) bleeding. There were 248 deaths: 32 deaths among men with bleeding versus 107 deaths among men with no bleeding (9.1% vs 3.6%, OR 2.68 [1.78-4.05], P < .001) and 40 deaths among women with bleeding vs 69 deaths among women with no bleeding (7.8% vs 2.5%, OR 3.35 [2.24-5.01], P < .001). No difference in mortality was observed among women and men who bled (P = .487). Bleeding was independently associated 1-year mortality (adjusted hazard ratio 2.18 [1.68-2.84], P < .001) with no bleeding-by-sex interaction (P = .439).
Despite matching for age, body mass index, and type of antithrombotic therapy, bleeding risk after PCI remained significantly higher in women than in men. Bleeding was associated with increased risk of 1-year mortality with no bleeding-by-sex interaction.
与男性相比，女性经皮冠状动脉介入治疗（PCI）后出血风险增加的相关因素仍不完全清楚。
该研究纳入了 3351 名女性和 3351 名年龄、体重指数和抗血栓治疗类型相匹配的男性。使用出血学术研究联合会（BARC）标准定义 PCI 后 30 天内的出血。主要结局为 1 年死亡率。
518 名女性和 354 名男性发生出血（15.5% vs 10.6%，比值比[OR] 1.55，95%置信区间[CI] 1.34-1.79，P<.001）。严重出血（BARC 分级≥2）（9.4% vs 6.5%，P<.001）和入路部位出血（10.1% vs 5.4%，P<.001）在女性中更为常见。调整后，女性仍然是任何出血（调整 OR 1.61 [1.35-1.92]，P<.001）和入路部位出血（调整 OR 2.00 [1.59-2.50]，P<.001）的独立相关因素，但不是非入路部位出血（调整 OR 1.18 [0.91-1.54]，P=0.205）的独立相关因素。共有 248 例死亡：出血男性 32 例，无出血男性 107 例（9.1% vs 3.6%，OR 2.68 [1.78-4.05]，P<.001），出血女性 40 例，无出血女性 69 例（7.8% vs 2.5%，OR 3.35 [2.24-5.01]，P<.001）。出血女性和男性的死亡率无差异（P=0.487）。出血与 1 年死亡率独立相关（调整后的危险比 2.18 [1.68-2.84]，P<.001），出血性别间无交互作用（P=0.439）。
尽管在年龄、体重指数和抗血栓治疗类型方面进行了匹配，但女性 PCI 后出血风险仍明显高于男性。出血与 1 年死亡率增加相关，且出血性别间无交互作用。
