性别差异对急性冠状动脉综合征经皮冠状动脉介入治疗后 30 天内再入院率的影响。
Gender Differences in the Rate of 30-Day Readmissions after Percutaneous Coronary Intervention for Acute Coronary Syndrome.
机构信息
Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
Department of Complementary and Integrative Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
出版信息
Womens Health Issues. 2019 Jan-Feb;29(1):17-22. doi: 10.1016/j.whi.2018.09.002. Epub 2018 Oct 25.
BACKGROUND
It has been reported that women have higher 30-day readmission rates than men after acute coronary syndrome (ACS). However, readmission after percutaneous coronary intervention (PCI) for ACS is a distinct subset of patients in whom gender differences have not been adequately studied.
METHODS
Hawaii statewide hospitalization data from 2010 to 2015 were assessed to compare gender differences in 30-day readmission rates among patients hospitalized with ACS who underwent PCI during the index hospitalization. Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare and Medicaid Services Condition Categories. Multivariable logistic regression was applied to evaluate the effect of gender on the 30-day readmission rate.
RESULTS
A total of 5,354 patients (29.4% women) who were hospitalized with a diagnosis of ACS and underwent PCI were studied. Overall, women were older, with more identified as Native Hawaiian, and had a higher prevalence of cardiovascular risk factors compared with men. The 30-day readmission rate was 13.9% in women and 9.6% in men (p < .0001). In the multivariable model, female gender (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.09-1.60), Medicaid (OR, 1.48; 95% CI, 1.07-2.06), Medicare (1.72; 95% CI, 1.35-2.19), heart failure (1.88; 95% CI, 1.53-2.33), atrial fibrillation (OR, 1.54; 95% CI-1.21-1.95), substance use (OR, 1.88; 95% CI, 1.27-2.77), history of gastrointestinal bleeding (OR, 2.43; 95% CI, 1.29-4.58), and chronic kidney disease (OR, 1.78; 95% CI, 1.42-2.22) were independent predictors of 30-day readmissions. Readmission rates were highest during days 1 through 6 (peak, day 3) after discharge. The top three cardiac causes of readmissions were heart failure, recurrent angina, and recurrent ACS.
CONCLUSIONS
Female gender is an independent predictor of 30-day readmission after ACS that requires PCI. Our finding suggests women are at a higher risk of post-ACS cardiac events such as heart failure and recurrent ACS, and further gender-specific intervention is needed to reduce 30-day readmission rate in women after ACS.
背景
据报道，女性在急性冠状动脉综合征（ACS）后 30 天的再入院率高于男性。然而，ACS 经皮冠状动脉介入治疗（PCI）后的再入院是患者中一个独特的亚组，其性别差异尚未得到充分研究。
方法
评估了 2010 年至 2015 年夏威夷全州住院数据，以比较因 ACS 住院并在指数住院期间接受 PCI 的患者中，30 天再入院率的性别差异。再入院诊断使用医疗保险和医疗补助服务条件类别（Centers for Medicare and Medicaid Services Condition Categories）的聚合版本进行分类。多变量逻辑回归用于评估性别对 30 天再入院率的影响。
结果
共纳入 5354 名（29.4%为女性）诊断为 ACS 并接受 PCI 的患者。总体而言，女性年龄较大，被认定为夏威夷原住民的比例较高，且心血管危险因素的患病率高于男性。女性 30 天再入院率为 13.9%，男性为 9.6%（p<0.0001）。在多变量模型中，女性（比值比[OR]，1.32；95%置信区间[CI]，1.09-1.60）、医疗补助（OR，1.48；95% CI，1.07-2.06）、医疗保险（OR，1.72；95% CI，1.35-2.19）、心力衰竭（OR，1.88；95% CI，1.53-2.33）、心房颤动（OR，1.54；95% CI，1.21-1.95）、物质使用（OR，1.88；95% CI，1.27-2.77）、胃肠道出血史（OR，2.43；95% CI，1.29-4.58）和慢性肾脏病（OR，1.78；95% CI，1.42-2.22）是 30 天再入院的独立预测因素。再入院率在出院后第 1 天至第 6 天（高峰，第 3 天）最高。再入院的三个主要心脏原因是心力衰竭、复发性心绞痛和复发性 ACS。
结论
女性是 ACS 后需要 PCI 治疗的 30 天再入院的独立预测因素。我们的研究结果表明，女性发生心力衰竭和复发性 ACS 等 ACS 后心脏事件的风险更高，需要进一步进行针对女性的特定干预，以降低 ACS 后女性的 30 天再入院率。
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