年龄和性别对慢性完全闭塞性经皮冠状动脉介入治疗住院结局的影响

The Impact of Age and Sex on In-Hospital Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention.

作者信息

Karatasakis Aris, Iwnetu Rahel, Danek Barbara A, Karmpaliotis Dimitri, Alaswad Khaldoon, Jaffer Farouc A, Yeh Robert W, Kandzari David E, Lembo Nicholas J, Patel Mitul, Mahmud Ehtisham, Lombardi William L, Wyman R Michael, Grantham J Aaron, Doing Anthony H, Toma Catalin, Choi James W, Uretsky Barry F, Moses Jeffrey W, Kirtane Ajay J, Ali Ziad A, Parikh Manish, Karacsonyi Judit, Rangan Bavana V, Thompson Craig A, Banerjee Subhash, Brilakis Emmanouil S

机构信息

Minneapolis Heart Institute, 920 E. 28th Street #300, Minneapolis, MN 55407 USA.

出版信息

J Invasive Cardiol. 2017 Apr;29(4):116-122. Epub 2017 Jan 15.

PMID:28089997

Abstract

OBJECTIVES

We sought to determine the effect of age and sex on procedural outcomes and efficiency of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

METHODS

We examined the clinical and angiographic characteristics and outcomes of 1675 CTO-PCIs performed in 1644 patients between 2012 and 2016 at 15 United States centers.

RESULTS

Mean age was 65.3 ± 10 years and 1408 (86%) were men. Overall technical and procedural success rates were 88% and 87%, respectively. Increasing age was associated with more comorbidities (dyslipidemia, hypertension, prior coronary artery bypass graft surgery, prior stroke, peripheral arterial disease, and chronic lung disease) and more lesion calcification. As compared with the reference age of <65 years, age >75 years was independently associated with technical failure (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.20-4.28). Increasing age was also independently associated with the incidence of major adverse cardiovascular events (MACEs; OR, 2.93; 95% CI, 1.10-9.23 for 65-75 years and OR, 5.71; 95% CI, 1.89-19.60 for >75 years). Compared with men, women (n = 236; 14%) were older (66.8 ± 11.1 years vs 65.0 ± 9.8 years; P=.02), but had similar clinical characteristics and lower J-CTO scores (2.3 ± 1.3 vs 2.5 ± 1.2; P=.02). Although crude technical success rate was higher in women compared with men (92% vs 87%; P=.04), multivariable analysis did not show independent association between sex and technical failure (OR, men/women, 1.66; 95% CI, 0.86-3.50) or MACE (OR, 0.61; 95% CI, 0.25-1.73).

CONCLUSIONS

Older age, but not sex, is associated with lower technical success and higher in-hospital complication rate for CTO-PCI. CTO-PCI is relatively infrequently attempted in women, despite high technical success and acceptable complication rates.

摘要

目的

我们试图确定年龄和性别对慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的手术结果和效率的影响。

方法

我们研究了2012年至2016年期间在美国15个中心对1644例患者进行的1675例CTO-PCI的临床和血管造影特征及结果。

结果

平均年龄为65.3±10岁，1408例（86%）为男性。总体技术成功率和手术成功率分别为88%和87%。年龄增长与更多的合并症（血脂异常、高血压、既往冠状动脉旁路移植术、既往中风、外周动脉疾病和慢性肺病）以及更多的病变钙化相关。与<65岁的参考年龄相比，>75岁独立与技术失败相关（比值比[OR]，2.28；95%置信区间[CI]，1.20-4.28）。年龄增长也独立与主要不良心血管事件（MACE）的发生率相关（65-75岁时OR，2.93；95%CI，1.10-9.23；>75岁时OR，5.71；95%CI，1.89-19.60）。与男性相比，女性（n = 236；14%）年龄更大（66.8±11.1岁对65.0±9.8岁；P = 0.02），但具有相似的临床特征且J-CTO评分更低（2.3±1.3对2.5±1.2；P = 0.02）。尽管女性的粗技术成功率高于男性（92%对87%；P = 0.04），但多变量分析未显示性别与技术失败（OR，男性/女性，1.66；95%CI，0.86-3.50）或MACE（OR，0.61；95%CI，0.25-1.73）之间存在独立关联。