Mannem Santhosh, Rattanawong Pattara, Riangwiwat Tanawan, Vutthikraivit Wasawat, Putthapiban Prapaipan, Sukhumthammarat Weera, Kanitsoraphan Chanavuth, Chongsathidkiet Pakawat
The Queen's Medical Center, Honolulu, HI, USA.
University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA; Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Cardiovasc Revasc Med. 2020 Jan;21(1):25-31. doi: 10.1016/j.carrev.2019.03.003. Epub 2019 Mar 21.
Recent studies suggest that sex difference is an outcome predictor in chronic total occlusion (CTO) patients who are undergoing percutaneous intervention (PCI). However, a systematic review and meta-analysis of the literature have not been done. We assessed the outcome of PCI in CTO between male and female.
We comprehensively searched the databases of MEDLINE and EMBASE from inception to September 2017. Included studies were published cohort (prospective or retrospective) and case control studies of CTO patients who underwent PCI that compared successful procedure and major cardiac event (MACE), including cardiac death, target vessel revascularization, myocardial infarction, and stroke, between male and female. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals.
Nine studies were included in this meta-analysis involving 30,830 CTO subjects (8350 female and 22,480 male) who underwent PCI. Females were not significantly associated with reduced risk of MACE (pooled risk ratio = 0.86, 95% confidence interval: 0.66-1.12, p = 0.262, I = 47.0%) as well as successful rate of PCI (pooled risk ratio = 1.04, 95% confidence interval: 0.99-1.10, p = 0.161, I = 76.6%) in CTO patients who underwent PCI.
Our study suggests that sex is not an independent risk factor of MACE or successful procedure in CTO patients who underwent PCI.
近期研究表明，性别差异是接受经皮介入治疗（PCI）的慢性完全闭塞（CTO）患者的预后预测因素。然而，尚未对相关文献进行系统评价和荟萃分析。我们评估了CTO患者PCI治疗中男性和女性的预后。
我们全面检索了MEDLINE和EMBASE数据库，检索时间从建库至2017年9月。纳入的研究为已发表的队列研究（前瞻性或回顾性）以及CTO患者接受PCI治疗的病例对照研究，这些研究比较了男性和女性患者PCI手术成功及主要心脏事件（MACE）情况，MACE包括心源性死亡、靶血管血运重建、心肌梗死和中风。采用DerSimonian和Laird的随机效应、通用逆方差法合并每项研究的数据，以计算风险比和95%置信区间。
本荟萃分析纳入了9项研究，共30830例接受PCI治疗的CTO患者（女性8350例，男性22480例）。女性患者发生MACE的风险降低与PCI成功率均无显著相关性（合并风险比=0.86，95%置信区间：0.66 - 1.12，p = 0.262，I² = 47.0%）以及PCI成功率（合并风险比=1.04，95%置信区间：0.99 - |1.10，p = 0.161，I² = 76.6%）。
我们的研究表明，对于接受PCI治疗的CTO患者，性别并非MACE或手术成功的独立危险因素。
