Cardiology Department. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV).
Cardiology Department. Complejo Hospitalario Universitario de Santiago de Compostela. Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV).
Eur J Intern Med. 2020 Nov;81:26-31. doi: 10.1016/j.ejim.2020.06.011. Epub 2020 Jun 18.
There is insufficient data regarding sex-related prognostic differences in patients with a non-ST elevation acute coronary syndrome (NSTEACS). We performed a sex-specific analysis of cardiovascular outcomes after NSTEACS using a large contemporary cohort of patients from two tertiary hospitals.
This work is a retrospective analysis from a prospective registry, that included 5,686 consecutive NSTEACS patients from two Spanish University hospitals between the years 2005 and 2017. We performed a propensity score matching to obtain a well-balanced subset of individuals with the same clinical characteristics, resulting in 3,120 patients. Cox regression models performed survival analyses once the proportional risk test was verified.
Among the study participants, 1,572 patients (27.6%) were women. The mean follow-up was 60.0 months (standard deviation of 32 months). Women had a higher risk of cardiovascular mortality compared with men (OR (Odds ratio) 1.27, CI (confidence interval) 95% 1.08-1.49), heart failure (HF) hospitalization (OR 1.39, CI 95% 1.18-1.63) and risk of all-cause mortality (OR 1.10, CI 95% 1.08-1.49). After a propensity score matching, female gender was associated with a significant reduction in the risk of total mortality (OR 0.77, CI 95% 0.65-0.90) with a similar risk of cardiovascular mortality (OR 0.86, CI 0.71-1.03) and HF hospitalization (OR 0.92, CI 95% 0.68-1.23). After baseline adjustment, the risk of all-cause mortality and cardiovascular mortality was lower in women, whereas the risk of HF remained similar among sexes.
In a contemporary cohort of patients with NSTEACS, women are at similar risk of developing early and late HF admissions, and have better survival compared with men, with a lower risk of all-cause mortality and cardiovascular mortality. The implementation of NSTEACS guideline recommendations in women, including early revascularization, seems to be accompanied by improved early and long-term prognosis.
在非 ST 段抬高型急性冠状动脉综合征（NSTEACS）患者中，关于性别相关预后差异的数据不足。我们使用来自两家三级医院的大型当代队列患者，对 NSTEACS 后的心血管结局进行了性别特异性分析。
这项工作是对一项前瞻性登记研究的回顾性分析，该研究纳入了 2005 年至 2017 年期间来自西班牙两家大学医院的 5686 例连续 NSTEACS 患者。我们进行了倾向评分匹配，以获得具有相同临床特征的个体的良好平衡子集，最终得到 3120 例患者。一旦验证了比例风险检验，Cox 回归模型就进行了生存分析。
在研究参与者中，有 1572 例（27.6%）为女性。平均随访时间为 60.0 个月（标准差为 32 个月）。与男性相比，女性发生心血管死亡率（OR 1.27，95%CI 1.08-1.49）、心力衰竭（HF）住院（OR 1.39，95%CI 1.18-1.63）和全因死亡率（OR 1.10，95%CI 1.08-1.49）的风险更高。经过倾向评分匹配后，女性性别与总死亡率风险显著降低相关（OR 0.77，95%CI 0.65-0.90），心血管死亡率（OR 0.86，95%CI 0.71-1.03）和 HF 住院（OR 0.92，95%CI 0.68-1.23）的风险相似。在基线调整后，女性的全因死亡率和心血管死亡率风险较低，而男女 HF 风险相似。
在当代 NSTEACS 患者队列中，女性发生早期和晚期 HF 入院的风险相似，与男性相比生存率更高，全因死亡率和心血管死亡率风险较低。在女性中实施 NSTEACS 指南建议，包括早期血运重建，似乎伴随着早期和长期预后的改善。
