Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23?3RE, UK.
Cardiology Department, Barts Heart Centre, Barts Health NHS Trust, London, UK.
Europace. 2018 Jun 1;20(6):897-901. doi: 10.1093/europace/eux203.
Women traditionally have been and are still underrepresented in research in many important areas of cardiology, and guideline recommendations which also encompass women are mostly based on research conducted predominantly in men. However, there is plausible cause to believe that sex may have a potential influence on the benefit derived from the implantable cardioverter-defibrillators (ICD), alone or in association with cardiac resynchronization therapy. We assessed the possible relationship between sex and outcome with ICD implantation in the setting of primary prevention, by pooling the results of MUSTT, MADIT-II, DEFINITE, COMPANION, SCD-HeFT and DANISH trials in a meta-analysis. We pooled results for female and male patients separately. The results suggest that women as a group do not seem to obtain a significant survival benefit from the primary prevention ICD, contrary to men. This in turn may also have contributed to a relative underestimation of the ICD benefit among males when looking at the results in total. It is time for the medical and research communities to actively question the presumed overarching benefit of ICDs irrespective of sex and engage in systematic scientific efforts to definitively evaluate the value of this intervention in women.
在许多重要的心脏病学研究领域，女性传统上一直处于代表性不足的地位，并且涵盖女性的指南建议主要基于主要在男性中进行的研究。然而，有合理的理由相信，性别可能会对植入式心脏复律除颤器（ICD）单独或与心脏再同步治疗联合应用的获益产生潜在影响。我们通过荟萃 MUSTT、MADIT-II、DEFINITE、COMPANION、SCD-HeFT 和 DANISH 试验的结果进行荟萃分析，评估了性别与原发性预防中 ICD 植入相关结局之间的可能关系。我们分别对女性和男性患者的结果进行了汇总。结果表明，女性群体似乎并未从原发性预防 ICD 中获得显著的生存获益，这与男性相反。这反过来也可能导致在总体上观察结果时，男性的 ICD 获益被相对低估。现在是医疗和研究界积极质疑 ICD 不论性别普遍获益的时候了，并进行系统的科学努力，以明确评估该干预措施对女性的价值。
