Wada Hideki, Ogita Manabu, Miyauchi Katsumi, Tsuboi Shuta, Konishi Hirokazu, Shitara Jun, Kunimoto Mitsuhiro, Sonoda Taketo, Iso Takashi, Ebina Hideki, Aoki Eriko, Kitamura Kenichi, Tamura Hiroshi, Suwa Satoru, Daida Hiroyuki
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Cardiology, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka, 410-2295, Japan.
Cardiovasc Interv Ther. 2017 Oct;32(4):333-340. doi: 10.1007/s12928-016-0416-y. Epub 2016 Aug 8.
Acute coronary syndrome (ACS) is an important cause of mortality and morbidity in the general population. Recent advances in percutaneous coronary intervention (PCI) and optimal medical treatment have helped to improve the prognosis of patients with ACS. The previous reports indicated that women with ACS have a higher risk of adverse outcomes. However, sex differences in clinical outcomes with contemporary coronary revascularization and medical therapy for ACS have not been elucidated. We analyzed data from 676 consecutive patients with ACS (female, n = 166; male, n = 510) who were treated by emergency PCI between 2011 and 2014 at Juntendo Shizuoka Hospital. The patients were grouped according to sex. We defined major adverse cardiovascular events as a composite of all-cause death and ACS recurrence at 1 year and compared rates of major adverse cardiac events (MACE) between the groups. Women were older (75.4 ± 11.0 vs. 66.2 ± 12.2 years) and had a higher rate of multi-vessel disease, chronic kidney disease, and Killip IV at presentation. The cumulative rate of MACE at 1 year was significantly higher among women than men (17.5 vs. 10.2 %, p = 0.02, log-rank test). However, the association between women and a higher risk of MACE was attenuated after adjusting for age (HR 1.25, 95 % CI 0.77-2.00, p = 0.36) and other variables (HR 0.93, 95 % CI 0.36-2.44, p = 0.88). Adjustment for age and other risk factors attenuated sex differences in mid-term clinical outcomes among patients with ACS after emergency PCI.
急性冠状动脉综合征（ACS）是普通人群死亡和发病的重要原因。经皮冠状动脉介入治疗（PCI）和优化药物治疗的最新进展有助于改善ACS患者的预后。既往报告表明，患有ACS的女性不良结局风险更高。然而，当代冠状动脉血运重建和ACS药物治疗的临床结局中的性别差异尚未阐明。我们分析了2011年至2014年间在顺天堂静冈医院接受急诊PCI治疗的676例连续ACS患者（女性166例，男性510例）的数据。患者按性别分组。我们将主要不良心血管事件定义为1年时全因死亡和ACS复发的复合事件，并比较两组之间的主要不良心脏事件（MACE）发生率。女性年龄更大（75.4±11.0岁对66.2±12.2岁），且多支血管病变、慢性肾脏病和就诊时Killip IV级的发生率更高。1年时女性MACE的累积发生率显著高于男性（17.5%对10.2%，p = 0.02，对数秩检验）。然而，在调整年龄（HR 1.25，95%CI 0.77 - 2.00，p = 0.36）和其他变量（HR 0.93，95%CI 0.36 - 2.44，p = 0.88）后，女性与MACE高风险之间的关联减弱。调整年龄和其他风险因素后，急诊PCI后ACS患者中期临床结局的性别差异减弱。
