Udell Jacob A, Koh Maria, Qiu Feng, Austin Peter C, Wijeysundera Harindra C, Bagai Akshay, Yan Andrew T, Goodman Shaun G, Tu Jack V, Ko Dennis T
Women's College Research Institute and Cardiovascular Division, Department of Medicine, Women's College Hospital, University of Toronto, Ontario, Canada
Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada.
J Am Heart Assoc. 2017 Jan 20;6(1):e004319. doi: 10.1161/JAHA.116.004319.
Women hospitalized with a non-ST segment elevation acute coronary syndrome (ACS) have worse clinical outcomes compared with men. An early invasive strategy with prompt coronary revascularization may mitigate sex differences in outcomes. However, few contemporary studies have evaluated whether clinical outcomes differ between women and men presenting with ACS treated with an early invasive strategy.
A population-based cohort of hospitalized ACS patients who received prompt cardiac catheterization from 2008 to 2011 in Ontario, Canada and followed for up to 2 years was studied. Clinical outcomes were compared between men and women, stratified by the use of coronary revascularization. Inverse probability weighting using the propensity score accounted for measured differences in baseline characteristics between men and women. Among the 23 473 ACS patients who received cardiac catheterization during an index hospitalization, 66.1% of men and 51.8% of women received coronary revascularization during the same hospitalization. In the propensity-weighted cohort of patients who received coronary revascularization, the 1-year rate of death or recurrent ACS was 10.6% for men (referent) compared with 13.1% for women (hazard ratio 1.24; 95% CI 1.16-1.33). In contrast, outcomes for patients who did not receive coronary revascularization did not differ significantly between women and men at 1 year (17.8% versus 16.9%; hazard ratio 1.06; 95% CI 0.99-1.14) or at longer follow-up.
An increased risk of adverse clinical outcomes was observed for women with ACS undergoing an early invasive strategy and coronary revascularization compared with men.
与男性相比，因非ST段抬高型急性冠状动脉综合征（ACS）住院的女性临床结局更差。早期侵入性策略及迅速的冠状动脉血运重建可能会减轻结局方面的性别差异。然而，很少有当代研究评估采用早期侵入性策略治疗的ACS患者中，女性和男性的临床结局是否存在差异。
对2008年至2011年在加拿大安大略省住院并接受迅速心脏导管插入术且随访长达2年的ACS患者进行基于人群的队列研究。根据冠状动脉血运重建的使用情况，对男性和女性的临床结局进行比较。使用倾向评分的逆概率加权法对男性和女性基线特征的测量差异进行校正。在首次住院期间接受心脏导管插入术的23473例ACS患者中，66.1%的男性和51.8%的女性在同一住院期间接受了冠状动脉血运重建。在接受冠状动脉血运重建的倾向加权队列中，男性（参照组）1年死亡或复发性ACS发生率为10.6%，女性为13.1%（风险比1.24；95%CI 1.16-1.33）。相比之下，未接受冠状动脉血运重建的患者在1年（17.8%对16.9%；风险比1.06；95%CI 0.99-1.14）或更长随访期时，女性和男性的结局无显著差异。
与男性相比，接受早期侵入性策略和冠状动脉血运重建的ACS女性不良临床结局风险增加。
