Kim Hack-Lyoung, Jang Jae-Sik, Kim Myung-A, Seo Jae-Bin, Chung Woo-Young, Kim Sang-Hyun, Park Seung-Jung, Youn Tae-Jin, Yoon Myeong-Ho, Lee Jae-Hwan, Chang Kiyuk, Jeong Myung Ho, Choi Rak Kyeong, Hong Myeong-Ki, Kim Hyo-Soo
Division of Cardiology, Boramae Medical Center, Seoul National University College of Medicine, Seoul.
Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan.
Medicine (Baltimore). 2019 May;98(20):e15557. doi: 10.1097/MD.0000000000015557.
Most studies on gender difference of the in-hospital outcome of percutaneous coronary intervention (PCI) were performed in the pre-drug-eluting stents (DES) era. This study was performed to investigate whether gender influences the in-hospital outcome of PCI in the DES era.A total of 44,967 PCI procedure between January and December of 2014 from the nationwide PCI registry database in Korea were analyzed. The study population was male predominant (70.2%). We examined the association of gender with unadjusted and adjusted in-hospital mortality and composite events of PCI, including mortality, nonfatal myocardial infarction, stent thrombosis, stroke, urgent repeat PCI and bleeding requiring transfusion.Most of the study patients (91.3%) received DES. The incidence rates of in-hospital mortality (2.95% vs 1.99%, P <.001) and composite events (7.01% vs 5.48%, P <.001) were significantly higher in women compared to men. Unadjusted analyses showed that women had a 1.49 times higher risk of in-hospital mortality and a 1.30 times higher risk of composite events than men (P <.001 for each). After adjustment for potential confounders, female gender was not a risk factor for mortality (P = .258), but the risk of composite events remained 1.20 times higher in women than in men (P = .008).Among patients undergoing PCI in the contemporary DES era, female gender was associated with an increased risk of in-hospital composite events, but not in-hospital mortality. More careful attention should be emphasized to minimize procedure-related risks and to improve prognosis in women undergoing PCI.
大多数关于经皮冠状动脉介入治疗(PCI)院内结局性别差异的研究是在药物洗脱支架(DES)时代之前进行的。本研究旨在调查在DES时代性别是否会影响PCI的院内结局。
对韩国全国PCI注册数据库中2014年1月至12月期间的44967例PCI手术进行了分析。研究人群以男性为主(70.2%)。我们研究了性别与未经调整和调整后的院内死亡率以及PCI复合事件(包括死亡率、非致命性心肌梗死、支架血栓形成、中风、紧急重复PCI和需要输血的出血)之间的关联。
大多数研究患者(91.3%)接受了DES。女性的院内死亡率(2.95%对1.99%,P<0.001)和复合事件发生率(7.01%对5.48%,P<0.001)显著高于男性。未经调整的分析显示,女性院内死亡风险比男性高1.49倍,复合事件风险比男性高1.30倍(每项P<0.001)。在对潜在混杂因素进行调整后,女性性别不是死亡的危险因素(P=0.258),但女性复合事件风险仍比男性高1.20倍(P=0.008)。
在当代DES时代接受PCI的患者中,女性性别与院内复合事件风险增加相关,但与院内死亡率无关。对于接受PCI的女性,应更加重视尽量减少手术相关风险并改善预后。