Cardiology Department, Soroka Medical Center, Beer-Sheva, Israel Division of Cardiology, Department of Medicine McMaster University, Hamilton General Hospital 237 Barton Street East, Hamilton, ON L8L 2X2, Canada
Cardiology Department, Rambam Medical Center, Haifa, Israel.
Europace. 2014 Aug;16(8):1175-80. doi: 10.1093/europace/euu015. Epub 2014 Feb 19.
Implantable cardioverter-defibrillators (ICDs) improve survival in certain high arrhythmic risk populations. However, there are sex differences regarding both the utilization and the benefit of these devices. Using a prospective national ICD registry, we aim to compare the indications for ICD implantation as well as outcomes in implanted women vs. men.
All subjects implanted with an ICD or cardiac resynchronization therapy with a defibrillator (CRTD) in Israel between July 2010 and February 2013 were included. A total of 3544 subjects constructed the baseline cohort, of whom 615 (17%) were women. Women had the same age (64 years) and rate of secondary prevention indication (26%) as men. However, women were more likely than men to have significant heart failure symptoms (52 vs. 45%), QRS > 120 ms (41 vs. 36%), and a higher rate of non-ischaemic cardiomyopathy (54 vs. 21%, all P values <0.05). Using multivariate analysis, women were more likely to undergo CRTD implantation (odds ratio = 1.8, P < 0.01). Follow-up data were available for 1518 subjects with a mean follow-up of 12 months. During follow-up, there were no significant differences among genders in the rate of any single or the combined outcomes of appropriate device therapies, heart failure admissions, or death. First-year re-intervention rate was double among women (5.6 vs. 3.0%, P < 0.01).
In real-world setting, women implanted with an ICD differ significantly from men in their baseline characteristics and in the use of CRTD devices. These, however, did not translate into outcome differences.
植入式心脏复律除颤器（ICD）可改善某些高心律失常风险人群的生存率。然而，在这些设备的使用和受益方面存在性别差异。本研究使用前瞻性全国 ICD 登记处，旨在比较女性与男性 ICD 植入的适应证以及结局。
纳入 2010 年 7 月至 2013 年 2 月期间在以色列植入 ICD 或带除颤器的心脏再同步治疗（CRTD）的所有患者。共纳入 3544 例患者作为基线队列，其中 615 例（17%）为女性。女性的年龄（64 岁）和二级预防适应证（26%）与男性相同。然而，与男性相比，女性更有可能出现严重心力衰竭症状（52%比 45%，P<0.05）、QRS>120 ms（41%比 36%，P<0.05）和更高的非缺血性心肌病发生率（54%比 21%，所有 P 值均<0.05）。多变量分析显示，女性更有可能接受 CRTD 植入（比值比=1.8，P<0.01）。1518 例患者获得了随访数据，平均随访 12 个月。随访期间，女性与男性在适当的装置治疗、心力衰竭入院或死亡的任何单一或联合结局发生率方面无显著差异。女性的 1 年再干预率是男性的两倍（5.6%比 3.0%，P<0.01）。
在真实世界环境中，植入 ICD 的女性与男性在基线特征和 CRTD 设备的使用方面存在显著差异。然而，这些差异并未转化为结局差异。
