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女性心搏骤停后行冠状动脉造影和介入治疗。

Coronary Angiography and Intervention in Women Resuscitated From Sudden Cardiac Death.

机构信息

Maine Medical Center Portland ME.

Sarver Heart Center University of Arizona Tucson AZ.

出版信息

J Am Heart Assoc. 2020 Apr 7;9(7):e015629. doi: 10.1161/JAHA.119.015629. Epub 2020 Mar 25.

Abstract

Background Coronary artery disease is the primary etiology for sudden cardiac arrest in adults, but potential differences in the incidence and utility of invasive coronary testing between resuscitated men and women have not been extensively evaluated. Our aim was to characterize angiographic similarities and differences between men and women after cardiac arrest. Methods and Results Data from the International Cardiac Arrest Registry-Cardiology database included patients resuscitated from out-of-hospital cardiac arrest of presumed cardiac origin, admitted to 7 academic cardiology/resuscitation centers during 2006 to 2017. Demographics, clinical factors, and angiographic findings of subjects were evaluated in relationship to sex and multivariable logistic regression models created to predict both angiography and outcome. Among 966 subjects, including 277 (29%) women and 689 (71%) men, fewer women had prior coronary artery disease and more had prior congestive heart failure (=0.05). Women were less likely to have ST-segment-elevation myocardial infarction (32% versus 39%, =0.04). Among those with ST-segment-elevation myocardial infarctions, identification and distribution of culprit arteries was similar between women and men, and there were no differences in treatment or outcome. In patients without ST-segment elevation post-arrest, women were overall less likely to undergo coronary angiography (51% versus 61%, <0.02), have a culprit vessel identified (29% versus 45%, =0.03), and had fewer culprits acutely occluded (17% versus 28%, =0.03). Women were also less often re-vascularized (44% versus 52%, <0.03). Conclusions Among cardiac arrest survivors, women are less likely to undergo angiography or percutaneous coronary intervention than men. Sex disparities for invasive therapies in post-cardiac arrest care need continued attention.

摘要

背景

冠心病是成人心脏骤停的主要病因,但在复苏的男性和女性中,侵入性冠状动脉检测的发病率和实用性的潜在差异尚未得到广泛评估。我们的目的是描述心脏骤停后男性和女性的血管造影相似性和差异。

方法和结果

来自国际心脏骤停注册-心脏病学数据库的数据包括在 2006 年至 2017 年期间,在 7 个学术心脏病学/复苏中心因疑似心源性原因院外心脏骤停复苏的患者。评估了患者的人口统计学、临床因素和血管造影结果与性别之间的关系,并创建了多变量逻辑回归模型来预测血管造影和结果。在 966 名患者中,包括 277 名(29%)女性和 689 名(71%)男性,女性的既往冠心病发病率较低,充血性心力衰竭发病率较高(=0.05)。女性发生 ST 段抬高型心肌梗死的可能性较小(32% 比 39%,=0.04)。在发生 ST 段抬高型心肌梗死的患者中,女性和男性的罪犯动脉的识别和分布相似,在治疗或结果方面没有差异。在无 ST 段抬高的心脏骤停患者中,女性总体上不太可能进行冠状动脉造影(51%比 61%,<0.02),确定罪犯血管的可能性较小(29%比 45%,=0.03),急性闭塞的罪犯血管较少(17%比 28%,=0.03)。女性进行血运重建的可能性也较低(44%比 52%,<0.03)。

结论

在心脏骤停幸存者中,女性接受血管造影或经皮冠状动脉介入治疗的可能性低于男性。在心脏骤停后护理中,对侵入性治疗的性别差异需要持续关注。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac53/7428608/466438f0febe/JAH3-9-e015629-g001.jpg

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