Epps Kelly C, Holper Elizabeth M, Selzer Faith, Vlachos Helen A, Gualano Sarah K, Abbott J Dawn, Jacobs Alice K, Marroquin Oscar C, Naidu Srihari S, Groeneveld Peter W, Wilensky Robert L
From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.); Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.); Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.); Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.); Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.); Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.); and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.).
Circ Cardiovasc Qual Outcomes. 2016 Feb;9(2 Suppl 1):S16-25. doi: 10.1161/CIRCOUTCOMES.115.002482.
Women <50 years of age with coronary artery disease may represent a group at higher risk for recurrent ischemic events after percutaneous coronary intervention (PCI); however, no long-term, multicenter outcomes assessment exists in this population.
Using the National Heart, Lung, and Blood Institute Dynamic Registry, we evaluated the association of sex and age on cardiovascular-related outcomes in 10,963 patients (3797 women, 394 <50 years) undergoing PCI and followed for 5 years. Death, myocardial infarction, coronary artery bypass graft surgery, and repeat PCI were primary outcomes comprising major adverse cardiovascular events. Although procedural success rates were similar by sex, the cumulative rate of major adverse cardiovascular events at 1 year was higher in young women (27.8 versus 19.9%; P=0.003), driven largely by higher rates of repeat revascularizations for target vessel or target lesion failure (coronary artery bypass graft surgery: 8.9% versus 3.9%, P<0.001, adjusted hazard ratio 2.4, 95% confidence interval 1.5-4.0; PCI: 19.0% versus 13.0%, P=0.005, adjusted hazard ratio 1.6, 95% confidence interval 1.2-2.2). At 5 years, young women remained at higher risk for repeat procedures (coronary artery bypass graft surgery: 10.7% versus 6.8%, P=0.04, adjusted hazard ratio 1.71, 95% confidence interval 1.01-2.88; repeat PCI [target vessel]: 19.7% versus 11.8%, P=0.002, adjusted hazard ratio 1.8, 95% confidence interval 1.24-2.82). Compared with older women, younger women remained at increased risk of major adverse cardiovascular events, whereas all outcome rates were similar in older women and men.
Young women, despite having less severe angiographic coronary artery disease, have an increased risk of target vessel and target lesion failure. The causes of this difference deserve further investigation.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005677.
年龄小于50岁的冠心病女性可能是经皮冠状动脉介入治疗（PCI）后发生复发性缺血事件风险较高的群体；然而，该人群尚无长期、多中心的结局评估。
利用美国国立心肺血液研究所动态注册库，我们评估了10963例接受PCI并随访5年的患者（3797例女性，394例年龄小于50岁）中性别和年龄与心血管相关结局的关联。死亡、心肌梗死、冠状动脉旁路移植术和再次PCI是构成主要不良心血管事件的主要结局。尽管手术成功率在性别上相似，但年轻女性1年时主要不良心血管事件的累积发生率更高（27.8%对19.9%；P=0.003），这主要是由于靶血管或靶病变失败导致的再次血运重建率较高（冠状动脉旁路移植术：8.9%对3.9%，P<0.001，调整后风险比2.4，95%置信区间1.5-4.0；PCI：19.0%对13.0%，P=0.005，调整后风险比1.6，95%置信区间1.2-2.2）。在5年时，年轻女性再次手术的风险仍然较高（冠状动脉旁路移植术：10.7%对6.8%，P=0.04，调整后风险比1.71，95%置信区间1.01-2.88；再次PCI[靶血管]：19.7%对11.8%，P=0.002，调整后风险比1.8，95%置信区间1.24-2.82）。与老年女性相比，年轻女性发生主要不良心血管事件的风险仍然增加，而老年女性和男性的所有结局发生率相似。
年轻女性尽管冠状动脉造影显示的冠心病较轻，但靶血管和靶病变失败的风险增加。这种差异的原因值得进一步研究。
