Stähli Barbara Elisabeth, Gebhard Cathérine, Gick Michael, Ferenc Miroslaw, Mashayekhi Kambis, Buettner Heinz Joachim, Neumann Franz-Josef, Toma Aurel
Department of Cardiology, Charité Berlin-University Medicine, Campus Benjamin Franklin, Berlin, Germany.
Division of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany.
Am J Cardiol. 2017 Jun 15;119(12):1931-1936. doi: 10.1016/j.amjcard.2017.03.021. Epub 2017 Mar 29.
Conflicting evidence exists on gender differences in outcomes after coronary stenting, and gender-based data in patients with chronic total occlusions (CTO) who underwent percutaneous coronary intervention (PCI) are scarce. Consecutive patients who underwent CTO PCI from January 2005 to December 2013 were included in the analysis and stratified according to gender. The primary outcome measure was all-cause mortality. Median follow-up was 2.6 years (interquartile range 1.1 to 3.1). Of 2002 patients, 332 (17%) were women. Procedural success was achieved in 82% and 83% of women and men (p = 0.31). All-cause mortality was 15% and 11% in women and men (log-rank p = 0.17) with an adjusted hazard ratio of 0.85 (95% confidence interval [CI] 0.61 to 1.17, p = 0.31). All-cause mortality was significantly reduced in patients with procedural success, both in women (12% vs 32%, adjusted hazard ratio 0.44, 95% CI 0.24 to 0.79, p = 0.006) and men (9% vs 21%, adjusted hazard ratio 0.64, 95% CI 0.47 to 0.88, p = 0.006), with similar mortality benefits associated with successful revascularization in both groups (interaction p = 0.35). In conclusion, recanalization of coronary arterial CTO is equally successful in both women and men.
关于冠状动脉支架置入术后的结果，存在相互矛盾的性别差异证据，而接受经皮冠状动脉介入治疗（PCI）的慢性完全闭塞（CTO）患者的性别相关数据却很稀少。对2005年1月至2013年12月期间接受CTO PCI的连续患者进行分析，并按性别分层。主要结局指标是全因死亡率。中位随访时间为2.6年（四分位间距为1.1至3.1年）。在2002例患者中，332例（17%）为女性。女性和男性的手术成功率分别为82%和83%（p = 0.31）。女性和男性的全因死亡率分别为15%和11%（对数秩检验p = 0.17），校正后的风险比为0.85（95%置信区间[CI]为0.61至1.17，p = 0.31）。手术成功的患者全因死亡率显著降低，女性（12%对32%，校正后的风险比为0.44，95%CI为0.24至0.79，p = 0.006）和男性（9%对21%，校正后的风险比为0.64，95%CI为0.47至0.88，p = 0.006）均如此，两组成功血运重建带来的死亡率获益相似（交互作用p = 0.35）。总之，冠状动脉CTO再通在女性和男性中同样成功。
