Institute for Innovation in Mental and Physical Health and Clinical Treatment, Deakin University, Geelong, Vic, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.
Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.
Heart Lung Circ. 2020 Oct;29(10):1449-1458. doi: 10.1016/j.hlc.2020.03.001. Epub 2020 Mar 20.
To determine whether differential all-cause hospital readmission exists for men and women 2 years after percutaneous coronary intervention (PCI) treatment for acute coronary syndrome (ACS), and to identify potential autonomic and psychological pathways contributing to this association.
Four hundred and sixteen (416) patients admitted with ACS were recruited from coronary care wards. Participants attended the study centre at one (T0) and 12 (T1) months following discharge. Heart rate variability (HRV) was used to assess autonomic functioning measured via a three-lead electrocardiogram. Psychological variables of interest (pathological worry, depression and phobic anxiety) were measured using validated self-report questionnaires. Percutaneous coronary intervention treatment data were collected from hospital records. The primary outcome was 2-year all-cause hospital readmission (yes/no). Logistic regression modelling using both complete case analysis and multiple imputation analysis was applied.
Men who received PCI had a significant reduction in the odds of being rehospitalised over the following 2 years, relative to women who did not (OR=0.45, 95% CI=0.20, 0.98). No other group benefited to this extent. Adjustment for age, ACS severity and Very Low Frequency (VLF) Power appeared to strengthen the association in both the complete case analysis and multiple imputation analysis models. The inclusion of depression and worry also marginally explained these associations in the multiple imputation analysis model.
Men who receive PCI after ACS were less likely to be readmitted to hospital over the following 2 years than their female counterparts. The small sample size of women and observational study design limit interpretation of the findings. However, heart rate variability, specifically VLF power, requires further investigation as a driver of such sex-specific outcomes.
为了确定在急性冠状动脉综合征（ACS）经皮冠状动脉介入治疗（PCI）后 2 年，男性和女性是否存在全因住院再入院的差异，并确定导致这种相关性的潜在自主和心理途径。
从冠心病病房招募了 416 名因 ACS 入院的患者。参与者在出院后 1 个月（T0）和 12 个月（T1）时到研究中心就诊。心率变异性（HRV）用于评估通过三导联心电图测量的自主功能。使用经过验证的自我报告问卷测量了感兴趣的心理变量（病理性担忧、抑郁和恐惧症焦虑）。PCI 治疗数据从医院记录中收集。主要结局是 2 年全因住院再入院（是/否）。使用完整案例分析和多重插补分析均进行了逻辑回归建模。
与未接受 PCI 的女性相比，接受 PCI 的男性在接下来的 2 年内再次住院的可能性显著降低（OR=0.45，95%CI=0.20，0.98）。其他组没有受益到这种程度。在完整案例分析和多重插补分析模型中，调整年龄、ACS 严重程度和非常低频（VLF）功率似乎增强了这种关联。在多重插补分析模型中，纳入抑郁和担忧也略微解释了这些关联。
ACS 后接受 PCI 的男性在接下来的 2 年内再次住院的可能性低于女性。女性的样本量小和观察性研究设计限制了对这些发现的解释。然而，心率变异性，特别是 VLF 功率，需要进一步研究，以确定其是否为这种性别特异性结果的驱动因素。
