Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom.
Quality and Outcomes Research Unit Queen Elizabeth Hospital Birmingham United Kingdom.
J Am Heart Assoc. 2019 Nov 19;8(22):e013485. doi: 10.1161/JAHA.119.013485. Epub 2019 Nov 13.
Background Women are underrepresented in cardiac resynchronization therapy (CRT) trials. Some studies suggest that women fare better than men after CRT. We sought to explore clinical outcomes in women and men undergoing CRT-defibrillation or CRT-pacing in real-world clinical practice. Methods and Results A national database (Hospital Episode Statistics for England) was used to quantify clinical outcomes in 43 730 patients (women: 10 890 [24.9%]; men: 32 840 [75.1%]) undergoing CRT over 7.6 years, (median follow-up 2.2 years, interquartile range, 1-4 years). In analysis of the total population, the primary end point of total mortality (adjusted hazard ratio [aHR], 0.73; 95% CI, 0.69-0.76) and the secondary end point of total mortality or heart failure hospitalization (aHR, 0.79, 95% CI 0.75-0.82) were lower in women, independent of known confounders. Total mortality (aHR, 0.73; 95% CI, 0.70-0.76) and total mortality or heart failure hospitalization (aHR, 0.79; 95% CI, 0.75-0.82) were lower for CRT-defibrillation than for CRT-pacing. In analyses of patients with (aHR, 0.89; 95% CI, 0.80-0.98) or without (aHR, 0.70; 95% CI, 0.66-0.73) a myocardial infarction, women had a lower total mortality. In sex-specific analyses, total mortality was lower after CRT-defibrillation in women (aHR, 0.83; =0.013) and men (aHR, 0.69; <0.001). Conclusions Compared with men, women lived longer and were less likely to be hospitalized for heart failure after CRT. In both sexes, CRT-defibrillation was superior to CRT-pacing with respect to survival and heart failure hospitalization. The longest survival after CRT was observed in women without a history of myocardial infarction.
女性在心脏再同步治疗（CRT）试验中的代表性不足。一些研究表明，女性在 CRT 后表现优于男性。我们旨在探讨真实世界临床实践中接受 CRT 除颤或 CRT 起搏的女性和男性的临床结局。
利用英国医院入院统计数据库（Hospital Episode Statistics for England），在 7.6 年内对 43730 例接受 CRT 的患者（女性：10890[24.9%]；男性：32840[75.1%]）进行了临床结局量化分析（中位随访时间为 2.2 年，四分位间距 1-4 年）。在对总人群的分析中，女性的主要终点（全因死亡率）（调整后的危险比[aHR]，0.73；95%置信区间[CI]，0.69-0.76）和次要终点（全因死亡率或心力衰竭住院）（aHR，0.79，95%CI 0.75-0.82）均较低，独立于已知混杂因素。女性的全因死亡率（aHR，0.73；95%CI，0.70-0.76）和全因死亡率或心力衰竭住院率（aHR，0.79；95%CI，0.75-0.82）均低于 CRT 除颤组。在分析伴有（aHR，0.89；95%CI，0.80-0.98）或不伴（aHR，0.70；95%CI，0.66-0.73）心肌梗死的患者时，女性的全因死亡率较低。在按性别分层的分析中，女性 CRT 除颤组（aHR，0.83；=0.013）和男性 CRT 除颤组（aHR，0.69；<0.001）的全因死亡率均较低。
与男性相比，女性在 CRT 后寿命更长，心力衰竭住院率更低。在男性和女性中，CRT 除颤在生存率和心力衰竭住院率方面均优于 CRT 起搏。在没有心肌梗死病史的女性中，CRT 后生存时间最长。
