Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom.
University College London Hospitals and St Bartholomew's Hospital, London, United Kingdom.
PLoS One. 2018 Sep 4;13(9):e0203325. doi: 10.1371/journal.pone.0203325. eCollection 2018.
Prior studies have reported inconsistencies in the baseline risk profile, comorbidity burden and their association with clinical outcomes in women compared to men. More importantly, there is limited data around the sex differences and how these have changed over time in contemporary percutaneous coronary intervention (PCI) practice.
We used the Nationwide Inpatient Sample to identify all PCI procedures based on ICD-9 procedure codes in the United States between 2004-2014 in adult patients. Descriptive statistics were used to describe sex-based differences in baseline characteristics and comorbidity burden of patients. Multivariable logistic regressions were used to investigate the association between these differences and in-hospital mortality, complications, length of stay and total hospital charges. Among 6,601,526 patients, 66% were men and 33% were women. Women were more likely to be admitted with diagnosis of NSTEMI (non-ST elevation acute myocardial infarction), were on average 5 years older (median age 68 compared to 63) and had higher burden of comorbidity defined by Charlson score ≥3. Women also had higher in-hospital crude mortality (2.0% vs 1.4%) and any complications compared to men (11.1% vs 7.0%). These trends persisted in our adjusted analyses where women had a significant increase in the odds of in-hospital mortality men (OR 1.20 (95% CI 1.16,1.23) and major bleeding (OR 1.81 (95% CI 1.77,1.86).
In this national unselected contemporary PCI cohort, there are significant sex-based differences in presentation, baseline characteristics and comorbidity burden. These differences do not fully account for the higher in-hospital mortality and procedural complications observed in women.
先前的研究报告称，与男性相比，女性在基线风险特征、合并症负担及其与临床结局的关系方面存在不一致之处。更重要的是，关于性别差异的数据有限，以及这些差异在当代经皮冠状动脉介入治疗（PCI）实践中是如何随时间变化的。
我们使用全国住院患者样本，在美国 2004-2014 年期间，根据 ICD-9 手术代码识别所有 PCI 手术。描述性统计数据用于描述患者基线特征和合并症负担方面的性别差异。多变量逻辑回归用于调查这些差异与住院死亡率、并发症、住院时间和总住院费用之间的关联。在 6601526 名患者中，66%为男性，33%为女性。女性更有可能因 NSTEMI（非 ST 段抬高型急性心肌梗死）入院，平均年龄大 5 岁（中位数年龄为 68 岁，而男性为 63 岁），Charlson 评分≥3 定义的合并症负担更高。女性的住院死亡率（2.0%比 1.4%）和任何并发症（11.1%比 7.0%）也高于男性。这些趋势在我们的调整分析中仍然存在，女性的住院死亡率比男性显著增加（比值比 1.20（95%置信区间 1.16，1.23）和大出血（比值比 1.81（95%置信区间 1.77，1.86）。
在这个全国性的未选择的当代 PCI 队列中，在表现、基线特征和合并症负担方面存在显著的性别差异。这些差异并不能完全解释女性观察到的更高的住院死亡率和手术并发症。
