Barthélémy Olivier, Degrell Philippe, Berman Emmanuel, Kerneis Mathieu, Petroni Thibaut, Silvain Johanne, Payot Laurent, Choussat Remi, Collet Jean-Philippe, Helft Gerard, Montalescot Gilles, Le Feuvre Claude
Institut de cardiologie (AP-HP), université Paris 6, Pitié-Salpêtrière Hospital, Paris, France.
Institut de cardiologie (AP-HP), université Paris 6, Pitié-Salpêtrière Hospital, Paris, France.
Arch Cardiovasc Dis. 2015 Aug-Sep;108(8-9):428-36. doi: 10.1016/j.acvd.2015.03.002. Epub 2015 Apr 27.
Whether outcomes differ for women and men after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains controversial.
To compare 1-year outcomes after primary PCI in women and men with STEMI, matched for age and diabetes.
Consecutive women with STEMI of<24 hours' duration referred (August 2007 to January 2011) for primary PCI were compared with men matched for age and diabetes. Rates of all-cause mortality, target vessel revascularization (TVR) and major cardiovascular and cerebrovascular events (MACCE) (death/myocardial infarction/stroke) were assessed at 1 year.
Among 775 consecutive patients, 182 (23.5%) women were compared with 182 matched men. Mean age was 69±15 years, 18% had diabetes. Patient characteristics were similar, except for lower creatinine clearance (73±41 vs 82±38 μmol/L; P=0.041), more cardiogenic shock (14.8% vs 6.6%; P=0.017) and less radial PCI (81.3% vs 90.1%; P=0.024) in women. Rates of 1-year death (22.7% vs 18.1%), TVR (8.3% vs 6.0%) and MACCE (24.3% vs 20.9%) were not statistically different in women (P>0.05 for all). After exclusion of patients with shock (10.7%) and out-of-hospital cardiac arrest (6.6%), death rates were even more similar (11.3% vs 11.8%; P=0.10). Female sex was not independently associated with death (odds ratio 1.01, 95% confidence interval 0.55-1.87; P=0.97).
In our consecutive unselected patient population, women had similar 1-year outcomes to men matched for age and diabetes, after contemporary primary PCI for STEMI, despite having a higher risk profile at baseline.
经皮冠状动脉介入治疗（PCI）后，ST段抬高型心肌梗死（STEMI）的女性和男性患者预后是否存在差异仍存在争议。
比较年龄和糖尿病相匹配的STEMI女性和男性患者接受直接PCI后的1年预后。
将2007年8月至2011年1月转诊接受直接PCI且STEMI病程<24小时的连续女性患者与年龄和糖尿病相匹配的男性患者进行比较。评估1年时的全因死亡率、靶血管血运重建（TVR）率和主要心血管和脑血管事件（MACCE）（死亡/心肌梗死/卒中）发生率。
在775例连续患者中，182例（23.5%）女性与182例匹配的男性进行了比较。平均年龄为69±15岁，18%患有糖尿病。除女性肌酐清除率较低（73±41 vs 82±38 μmol/L；P=0.041）、心源性休克更多（14.8% vs 6.6%；P=0.017）和桡动脉PCI较少（81.3% vs 90.1%；P=0.024）外，患者特征相似。女性1年死亡率（22.7% vs 18.1%）、TVR率（8.3% vs 6.0%）和MACCE发生率（24.3% vs 20.9%）无统计学差异（P均>0.05）。排除休克患者（10.7%）和院外心脏骤停患者（6.6%）后，死亡率更为相似（11.3% vs 11.8%；P=0.10）。女性性别与死亡无独立相关性（比值比1.01，95%置信区间0.55-1.87；P=0.97）。
在我们连续入选的患者群体中，尽管STEMI患者在当代直接PCI治疗后的基线风险较高，但女性与年龄和糖尿病相匹配的男性患者1年预后相似。
