Takagi Kensuke, Chieffo Alaide, Shannon Joanne, Naganuma Toru, Tahara Satoko, Fujino Yusuke, Latib Azeem, Montorfano Matteo, Carlino Mauro, Kawamoto Hiroyoshi, Nakamura Sunao, Colombo Antonio
Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
Cardiovasc Revasc Med. 2016 Sep;17(6):369-74. doi: 10.1016/j.carrev.2016.05.007. Epub 2016 Jun 15.
Although percutaneous intervention (PCI) for ULM is common, the impact of gender remains unclear. This study aimed to clarify the impact of gender in patients treated with drug-eluting stents (DES) for unprotected left main (ULM) disease.
Between April 2002 and August 2011, 1026 consecutive patients (212 women and 814 men) undergoing PCI using first or second generation DES for ULM stenosis were analyzed. Study endpoints included major adverse cardiac events (MACE) defined as composite of all-cause death, myocardial infarction (MI), and target lesion revascularization (TLR). Individual components of MACE and cardiac death were also evaluated.
Women had greater comorbidity and more complex lesions, resulting in a higher incidence of cardiac death, TLR and MI {[HR, 1.94 (95% CI, 1.22-3.09, p=0.005)], [HR, 1.31 (95% CI 0.96-1.81), p=0.09] and [HR, 2.04 (95% CI, 0.98-4.25), p=0.06], respectively}. Propensity score matching identified 131 matched pairs. There were no differences in MACE [HR, 1.04 (95% CI, 0.68-1.61, p=0.85)], all-cause death [HR, 0.96 (95% CI, 0.52-1.77), p=0.89] or MI [HR, 0.84 (95% CI, 0.21-3.50, p=0.84)]. However, cardiac death [HR, 2.70 (95% CI, 0.98-7.49, p=0.056] and TLR [HR, 1.62 (95% CI, 0.93-2.84), p=0.09] showed a trend to being higher in women compared to men.
In patients with ULM disease, women had greater comorbidity and more complex lesions, resulting in an increased risk of clinical events. However after propensity matching, there was no difference in the occurrence of MACE but cardiac death showed a trend to being higher in women compared to men.
尽管对无保护左主干（ULM）进行经皮介入治疗（PCI）很常见，但性别影响仍不明确。本研究旨在阐明性别对接受药物洗脱支架（DES）治疗无保护左主干（ULM）疾病患者的影响。
对2002年4月至2011年8月期间连续1026例接受第一代或第二代DES治疗ULM狭窄的患者（212例女性和814例男性）进行分析。研究终点包括主要不良心脏事件（MACE），定义为全因死亡、心肌梗死（MI）和靶病变血运重建（TLR）的复合事件。还评估了MACE的各个组成部分和心源性死亡。
女性合并症更多且病变更复杂，导致心源性死亡、TLR和MI的发生率更高{[风险比（HR），1.94（95%置信区间，1.22 - 3.09，p = 0.005）]，[HR，1.31（95%置信区间0.96 - 1.81），p = 0.09]和[HR，2.04（95%置信区间，0.98 - 4.25），p = 0.06]，分别}。倾向评分匹配确定了131对匹配病例。MACE[HR，1.04（95%置信区间，0.68 - 1.61，p = 0.85）]、全因死亡[HR，0.96（95%置信区间，0.52 - 1.77），p = 0.89]或MI[HR，0.84（95%置信区间，0.21 - 3.50），p = 0.84]方面无差异。然而，女性的心源性死亡[HR，2.70（95%置信区间，0.98 - 7.49，p = 0.056）]和TLR[HR，1.62（95%置信区间，0.93 - 2.84），p = 0.09]与男性相比有升高趋势。
在ULM疾病患者中，女性合并症更多且病变更复杂，导致临床事件风险增加。然而，倾向匹配后，MACE的发生率无差异，但女性的心源性死亡与男性相比有升高趋势。
