Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota.
Division of Cardiology, Department of Medicine, University of Kentucky, Lexington, Kentucky.
Am J Cardiol. 2020 Oct 1;132:1-7. doi: 10.1016/j.amjcard.2020.07.014. Epub 2020 Jul 13.
This study sought to examine the differences in the characteristics and outcomes between men and women who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) in contemporary US practice. The Nationwide Inpatient Sample was used to identify patients who underwent revascularization for AMI between January 1, 2003 and December 31, 2016. The primary outcome was in-hospital mortality. Propensity score matching was utilized to account for differences in baseline characteristics. In total, 3,603,142 patients were included, of whom only 1,180,436 (33%) were women. Compared with men, women were older and had higher prevalence of key co-morbidities including diabetes, hypertension, congestive heart failure, and chronic kidney and lung disease (p <0.001). In the PCI cohort, women were significantly less likely to undergo multivessel PCI, to receive mechanical circulatory support, or to undergo atherectomy. In the CABG group, women were more likely to have concomitant valve surgery. In the propensity-matched cohorts, in-hospital mortality was higher for women than men regardless of revascularization strategy: 7.6% versus 6.6% for PCI in ST-elevation myocardial infarction, 2.0% versus 1.9% for PCI in non-ST-elevation myocardial infarction, and 5.7% versus 4.3% for CABG in any AMI (p <0.001). Women also had higher rates of major complications, longer hospitalizations, higher costs, and were less likely to be discharged home (vs nursing facility). These sex-based differences persisted over the study 14-year period. In conclusion, in a contemporary nationwide analysis of propensity score-matched patients, women who undergo revascularization for AMI have worse in-hospital outcomes than men regardless of revascularization mode.
本研究旨在探讨在当代美国的实践中，因急性心肌梗死（AMI）而行经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）的男性和女性患者的特征和结局差异。使用全国住院患者样本（Nationwide Inpatient Sample）确定了 2003 年 1 月 1 日至 2016 年 12 月 31 日期间因 AMI 而行血运重建的患者。主要结局为院内死亡率。采用倾向评分匹配来考虑基线特征的差异。共纳入 3603142 名患者，其中仅 1180436 名（33%）为女性。与男性相比，女性年龄更大，且合并多种主要合并症的患病率更高，包括糖尿病、高血压、充血性心力衰竭、慢性肾病和肺病（p<0.001）。在 PCI 组中，女性行多支血管 PCI、机械循环支持或旋磨术的可能性显著降低。在 CABG 组中，女性更有可能同时行瓣膜手术。在倾向评分匹配队列中，无论采用何种血运重建策略，女性的院内死亡率均高于男性：ST 段抬高型心肌梗死行 PCI 者为 7.6%，而非 ST 段抬高型心肌梗死行 PCI 者为 2.0%，任何 AMI 行 CABG 者为 5.7%（p<0.001）。女性还具有更高的主要并发症发生率、更长的住院时间、更高的费用，且出院回家（而非疗养院）的可能性更小。这些基于性别的差异在研究的 14 年期间一直存在。总之，在一项针对倾向评分匹配患者的全国性分析中，无论血运重建模式如何，因 AMI 而行血运重建的女性患者的院内结局均比男性更差。
