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非急性心肌梗死患者经皮冠状动脉介入治疗后 1 年健康状况的性别差异:来自中国冠心病患者前瞻性研究的结果。

Sex Differences in 1-Year Health Status Following Percutaneous Coronary Intervention in Patients Without Acute Myocardial Infarction: Results From the China PEACE Prospective Study.

机构信息

National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, National Center for Cardiovascular Diseases Beijing People's Republic of China.

Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.

出版信息

J Am Heart Assoc. 2020 Mar 17;9(6):e014421. doi: 10.1161/JAHA.119.014421. Epub 2020 Mar 5.

Abstract

Background Sex differences in health status outcomes after percutaneous coronary intervention among patients without acute myocardial infarction are not well described. Methods and Results A total of 2237 patients (33.4% women) without acute myocardial infarction undergoing percutaneous coronary intervention were enrolled from 39 Chinese tertiary hospitals in the PEACE (China Patient-centered Evaluative Assessment of Cardiac Events) prospective percutaneous coronary intervention study. Data were collected immediately before and 1 year following percutaneous coronary intervention. Health status was measured using the disease-specific Seattle Angina Questionnaire (SAQ) Angina Frequency and Quality of Life domains, as well as the SAQ Summary Score. Among the study population, women were older, more often single, had lower levels of education, and had a higher prevalence of cardiac risk factors such as hypertension and diabetes mellitus. Women had lower mean 1-year SAQ Angina Frequency scores (mean±SD, 91.0±17.3 versus 93.9±13.3; <0.01), SAQ Quality of Life scores (mean±SD, 67.3±23.0 versus 70.6±21.6; <0.01), and SAQ Summary Scores (mean±SD, 81.6±13.8 versus 84.8±11.9; <0.01), a difference of marginal clinical significance that persisted after multivariable adjustment. A slightly larger improvement in the SAQ Summary Score was observed in women as compared with men (20.9±22.6 versus 18.5±21.3; =0.007) in unadjusted analysis. However, women were less likely to achieve clinically significant improvement in SAQ Angina Frequency (adjusted odds ratio, 0.67; 95% CI, 0.45-1.00) and SAQ Quality of Life (adjusted odds ratio, 0.73; 95% CI, 0.56-0.96) after adjustment. Conclusions There were no clinically significant differences in 1-year health status outcomes and improvement in health status by sex among patients without acute myocardial infarction following percutaneous coronary intervention. However, female sex was associated with poorer 1-year health status and a lower likelihood of experiencing clinically improvement in health status. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01624922.

摘要

背景

在无急性心肌梗死的经皮冠状动脉介入治疗患者中,健康状况结局的性别差异尚不清楚。

方法和结果

共有 2237 例(33.4%为女性)无急性心肌梗死的患者,在 PEACE(中国以患者为中心的心脏事件评估)前瞻性经皮冠状动脉介入治疗研究中,从中国 39 家三级医院中入选。数据在经皮冠状动脉介入治疗前和 1 年后立即采集。采用西雅图心绞痛问卷(SAQ)心绞痛频率和生活质量领域以及 SAQ 综合评分来衡量健康状况。在研究人群中,女性年龄较大,单身较多,受教育程度较低,且高血压和糖尿病等心脏危险因素的患病率较高。女性的 1 年平均 SAQ 心绞痛频率评分(均值±标准差,91.0±17.3 比 93.9±13.3;<0.01)、SAQ 生活质量评分(均值±标准差,67.3±23.0 比 70.6±21.6;<0.01)和 SAQ 综合评分(均值±标准差,81.6±13.8 比 84.8±11.9;<0.01)均较低,多变量调整后差异仍具有边际临床意义。与男性相比,女性 SAQ 综合评分的改善幅度稍大(未经调整分析,20.9±22.6 比 18.5±21.3;=0.007)。然而,女性在 SAQ 心绞痛频率(调整后的优势比,0.67;95%置信区间,0.45-1.00)和 SAQ 生活质量(调整后的优势比,0.73;95%置信区间,0.56-0.96)方面获得临床显著改善的可能性较低。

结论

在无急性心肌梗死的经皮冠状动脉介入治疗患者中,1 年健康状况结局和健康状况改善方面无性别差异。然而,女性性别与较差的 1 年健康状况和较低的临床健康状况改善可能性相关。

临床试验注册网址

https://www.clinicaltrials.gov/。唯一标识符:NCT01624922。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/73fc/7335522/e6872eca8d55/JAH3-9-e014421-g001.jpg

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