急性冠状动脉综合征中出血、死亡率与性别的关联：缺失的三角关系

Association of bleeding, mortality and sex in acute coronary syndromes: the missing triangle.

作者信息

Solinas Emilia, Vignali Luigi, Ortolani Paolo, Guastaroba Paolo, Marzocchi Antonio, Manari Antonio, De Palma Rossana, Mehran Roxana, Paoli Giorgia, Notarangelo Maria Francesca, Caminiti Caterina, Ardissino Diego, Merlini Piera Angelica

机构信息

aUnità Operativa di Cardiologia, Azienda Ospedaliero-Universitaria, Parma bIstituto di Cardiologia, Policlinico S. Orsola-Malpighi, Università di Bologna cAgenzia Sanitaria Regionale Regione Emilia-Romagna, Bologna dUnità Operativa di Cardiologia Interventistica, Ospedale Santa Maria Nuova, Reggio Emilia, Italy eZena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, USA fUnità Operativa Ricerca e Innovazione, Azienda Ospedaliero-Universitaria, Parma gUnità Operativa di Cardiologia, Ospedale Niguarda, Milan, Italy *Emilia Solinas and Luigi Vignali contributed equally to the writing of this article.

出版信息

J Cardiovasc Med (Hagerstown). 2015 May;16(5):347-54. doi: 10.2459/JCM.0000000000000174.

DOI:10.2459/JCM.0000000000000174

PMID:25252039

Abstract

AIMS

Percutaneous coronary intervention (PCI) and antithrombotic drugs are the standard therapy for patients with acute coronary syndromes (ACS), but their impact on bleeding and mortality in women has not been adequately investigated.

METHODS

This was a prospective observational cohort study of ACS patients, who were referred to 6 of the 13 centres belonging to the REgistro regionale AngiopLastiche dell'Emilia-Romagna programme in Emilia-Romagna for coronary angiography and PCI between June 2010 and November 2011. The aim of the study was to verify whether the incidence of Global Registry of Acute Coronary Events-defined in-hospital bleeding after an ACS is significantly higher in women than in men, and to evaluate its impact on short and long-term mortality.

RESULTS

The analysis involved a total of 1686 patients (511 women and 1175 men). The women were older and more frequently affected by hypertension, congestive heart failure and single-vessel disease; however, none of the clinical or procedural variables was significantly different between the sexes after statistical adjustment. There was a significantly higher rate of in-hospital bleeding among the women [8.6 vs. 5.8%; adjusted odds ratio 1.73, 95% confidence interval (CI) 1.19-2.52, P = 0.004], but the adjusted hazard ratio for short and long-term all-cause mortality was not significantly different. After optimal adjustment, bleeding, but not female sex, was identified as a predictor of short-term all-cause mortality (hazard ratio 2.68, 95% CI 1.21-5.93, P = 0.01), but this was not confirmed in the case of long-term mortality (hazard ratio 1.57, 95% CI 0.91-2.71, P = 0.10).

CONCLUSION

After optimal adjustment for baseline differences, the findings of this contemporary Italian PCI registry study showed that women experience bleeding more frequently, but do not have worse mortality outcomes than men. Bleeding was confirmed as an independent predictor of short-term mortality.

摘要

目的

经皮冠状动脉介入治疗（PCI）和抗血栓药物是急性冠状动脉综合征（ACS）患者的标准治疗方法，但其对女性出血和死亡率的影响尚未得到充分研究。

方法

这是一项对ACS患者的前瞻性观察队列研究，这些患者在2010年6月至2011年11月期间被转诊至艾米利亚 - 罗马涅地区REgistro regionale AngiopLastiche dell'Emilia-Romagna项目的13个中心中的6个中心进行冠状动脉造影和PCI。该研究的目的是验证ACS后全球急性冠状动脉事件注册研究定义的院内出血发生率在女性中是否显著高于男性，并评估其对短期和长期死亡率的影响。

结果

分析共纳入1686例患者（511例女性和1175例男性）。女性年龄较大，更频繁地患有高血压、充血性心力衰竭和单支血管病变；然而，经过统计调整后，性别之间的临床或手术变量均无显著差异。女性的院内出血率显著更高[8.6%对5.8%；调整后的优势比为1.73，95%置信区间（CI）为1.19 - 2.52，P = 0.004]，但短期和长期全因死亡率的调整后风险比无显著差异。经过最佳调整后，出血而非女性性别被确定为短期全因死亡率的预测因素（风险比为2.68，95%CI为1.21 - 5.93，P = 0.01），但在长期死亡率方面未得到证实（风险比为1.57，95%CI为0.91 - 2.71，P = 0.10）。