Krishnaswami Ashok, Chang Tara I, Jang James J, Leong Thomas K, Go Alan S
Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California.
Clin Cardiol. 2014 Sep;37(9):546-51. doi: 10.1002/clc.22306. Epub 2014 Jun 30.
Inadequate recruitment of women and an exclusion of patients with end-stage renal disease (ESRD) in coronary revascularization trials have led to knowledge gaps of gender-based outcomes.
Women have equivalent cardiovascular outcomes when compared to men.
We conducted a retrospective observational study utilizing Kaiser Permanente Northern California (KPNC) databases and identified 1015 adults with ESRD who underwent coronary revascularization between 1996 and 2008. We ascertained baseline characteristics, primary (mortality at 5 years) and secondary (myocardial infarction [MI] and repeat revascularization) outcomes from KPNC databases, state death certificates, and Social Security Administration files. A multivariable logistic regression was used to determine the association of gender to the prespecified outcomes.
Men and women were similar in age (P = 0.23). The mean number of baseline comorbidities was higher in women (2.7, 95% confidence interval [CI]: 2.5-2.9) compared to men (2.3, 95% CI: 2.1-2.4, P = 0.0002). The risk-adjusted odds ratios (OR) of female gender to death at 5 years (OR: 1.12, 95% CI: 0.83-1.52), MI (OR: 1.19, 95% CI: 0.86-1.64), and repeat revascularization (OR: 1.01, 95% CI: 0.70-1.45) were similar to men. Age modified the effect of gender for the primary outcome death (Pinteraction < 0.048), with a trend toward worse outcomes in younger women and improved outcomes in older women. This effect was noted more in patients who underwent coronary artery bypass grafting.
Although the overall relative risk of cardiovascular outcomes after coronary revascularization in ESRD was equivalent between men and women, age had a significant interaction with gender on overall mortality.
在冠状动脉血运重建试验中，女性招募不足以及终末期肾病（ESRD）患者被排除在外，导致了基于性别的结局方面的知识空白。
与男性相比，女性具有同等的心血管结局。
我们利用北加利福尼亚州凯撒医疗集团（KPNC）数据库进行了一项回顾性观察研究，确定了1996年至2008年间接受冠状动脉血运重建的1015例ESRD成年患者。我们从KPNC数据库、州死亡证明和社会保障管理档案中确定了基线特征、主要结局（5年死亡率）和次要结局（心肌梗死[MI]和再次血运重建）。使用多变量逻辑回归来确定性别与预先指定结局之间的关联。
男性和女性年龄相似（P = 0.23）。女性的基线合并症平均数量（2.7，95%置信区间[CI]：2.5 - 2.9）高于男性（2.3，95%CI：2.1 - 2.4，P = 0.0002）。女性在5年时死亡（OR：1.12，95%CI：0.83 - 1.52）、MI（OR：1.19，95%CI：0.86 - 1.64）和再次血运重建（OR：1.01，95%CI：0.70 - 1.45）的风险调整比值比与男性相似。年龄改变了性别对主要结局死亡的影响（P交互作用<0.048），年轻女性结局有变差趋势，老年女性结局有改善趋势。这种效应在接受冠状动脉旁路移植术的患者中更明显。
尽管ESRD患者冠状动脉血运重建后心血管结局的总体相对风险在男性和女性中相当，但年龄在总体死亡率上与性别有显著交互作用。
