Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut.
JACC Heart Fail. 2020 Sep;8(9):770-779. doi: 10.1016/j.jchf.2020.04.015. Epub 2020 Jul 8.
This study sought to use INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) results to evaluate sex differences in the use and clinical outcomes of left ventricular assist devices (LVAD).
Despite a similar incidence of heart failure in men and women, prior studies have highlighted potential underuse of LVADs in women, and studies of clinical outcomes have yielded conflicting results.
Patients were enrolled from the INTERMACS study who underwent implantation of their first continuous-flow LVAD between 2008 and 2017, and survival analyses stratified by sex were conducted.
Among the 18,868 patients, 3,984 (21.1%) were women. At 1 year, women were less likely to undergo heart transplantation than men (17.9% vs. 20.0%, respectively; p = 0.003). After multivariable adjustments, women had a higher risk of death (hazard ratio [HR]: 1.15; 95% confidence interval [CI]: 1.07 to 1.23; p < 0.001) and were more likely to incur post-implantation adverse events, including rehospitalization, bleeding, stroke, and pump thrombosis or device malfunction. Although women younger than 50 years of age had an increased risk of death compared to men of the same age (HR: 1.34; 95% CI: 1.12 to 1.6), men and women 65 years of age and older had a similar risk of death (HR: 1.09; 95% CI: 0.95 to 1.24).
This study found that women had a higher risk of mortality and adverse events after LVAD. Only 1 in 5 LVADs were implanted in women, and women were less likely to receive a heart transplant than men. Further investigation is needed to understand the causes of adverse events and potential underuse of advanced treatment options in women.
本研究旨在利用 INTERMACS（机械循环辅助支持机构注册中心）的结果，评估性别差异对左心室辅助装置（LVAD）使用和临床结局的影响。
尽管男性和女性心力衰竭的发病率相似，但先前的研究强调了女性 LVAD 潜在的使用不足，且临床结局研究得出的结果相互矛盾。
该研究纳入了 2008 年至 2017 年间接受首次连续血流 LVAD 植入的 INTERMACS 研究患者，并进行了按性别分层的生存分析。
在 18868 例患者中，3984 例（21.1%）为女性。1 年时，女性接受心脏移植的可能性低于男性（分别为 17.9%和 20.0%；p=0.003）。经过多变量调整后，女性的死亡风险更高（风险比[HR]：1.15；95%置信区间[CI]：1.07 至 1.23；p<0.001），且更易发生植入后不良事件，包括再住院、出血、卒中和泵血栓形成或设备故障。尽管 50 岁以下的女性与同龄男性相比死亡风险增加（HR：1.34；95%CI：1.12 至 1.6），但 65 岁及以上的男性和女性死亡风险相似（HR：1.09；95%CI：0.95 至 1.24）。
本研究发现，女性在 LVAD 后死亡风险和不良事件风险更高。仅有 1/5 的 LVAD 植入女性患者，且女性接受心脏移植的可能性低于男性。需要进一步研究以了解不良事件的原因以及女性潜在的先进治疗方案使用不足。
