复杂冠状动脉血运重建后十年全因死亡率的性别差异。

Sex Differences in All-Cause Mortality in the Decade Following Complex Coronary Revascularization.

机构信息

Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway, Galway, Ireland.

Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

出版信息

J Am Coll Cardiol. 2020 Aug 25;76(8):889-899. doi: 10.1016/j.jacc.2020.06.066.

DOI:10.1016/j.jacc.2020.06.066

PMID:32819461

Abstract

BACKGROUND

The poorer prognosis of coronary artery disease in females compared with males is related mainly to differences in baseline characteristics. In the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, the effect of treatment with percutaneous coronary intervention (PCI) versus coronary artery bypass grafting surgery (CABG) on mortality at 5 years differed significantly between females and males; however, the optimal revascularization beyond 5 years according to sex has not been evaluated.

OBJECTIVES

The aim of this study was to investigate the impact of sex on mortality and sex-treatment interaction at 10 years.

METHODS

The SYNTAXES (SYNTAX Extended Survival) study evaluated vital status up to 10 years in 1,800 patients with de novo 3-vessel and/or left main coronary artery disease randomized to treatment with PCI or CABG in the SYNTAX trial. All-cause death at 10 years was separately evaluated in female and male patients with complex coronary artery disease.

RESULTS

Of 1,800 patients, 402 (22.3%) were female and 1,398 (77.7%) were males. Females had a higher 10-year mortality rate compared with males (32.8% vs. 24.7%; log-rank p = 0.002), but female sex was not an independent predictor of mortality (adjusted hazard ratio: 1.02; 95% confidence interval: 0.76 to 1.36). Mortality at 10 years tended to be lower after CABG than after PCI, with a similar treatment effect for female and male patients (adjusted hazard ratio for females: 0.90 [95% confidence interval: 0.54 to 1.51]; adjusted hazard ratio for males: 0.76 [95% confidence interval: 0.56 to 1.02]; p for interaction = 0.952).

CONCLUSIONS

Female sex was not an independent predictor of mortality at 10 years in patients with complex coronary artery disease. The interaction between sex and treatment with PCI or CABG that was observed at 5 years was no longer present at 10 years. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES], NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX], NCT00114972).

摘要

背景

与男性相比，女性冠心病的预后较差，主要与基线特征的差异有关。在 SYNTAX（经皮冠状动脉介入治疗与紫杉醇协同作用及心脏手术）试验中，经皮冠状动脉介入治疗（PCI）与冠状动脉旁路移植术（CABG）治疗对 5 年死亡率的影响在女性和男性之间有显著差异；然而，根据性别评估超过 5 年的最佳血运重建效果尚未得到评估。

目的

本研究旨在探讨性别对 10 年死亡率和性别治疗相互作用的影响。

方法

SYNTAXES（SYNTAX 扩展生存）研究评估了 1800 例新发 3 支血管和/或左主干冠状动脉疾病患者的生存状态，这些患者在 SYNTAX 试验中随机接受 PCI 或 CABG 治疗，直至 10 年。对复杂冠状动脉疾病的女性和男性患者分别评估全因死亡率。

结果

在 1800 例患者中，402 例（22.3%）为女性，1398 例（77.7%）为男性。与男性相比，女性 10 年死亡率更高（32.8%比 24.7%；对数秩检验 p=0.002），但女性性别不是死亡率的独立预测因素（调整后的危险比：1.02；95%置信区间：0.76 至 1.36）。CABG 后的死亡率较 PCI 后有下降趋势，且女性和男性患者的治疗效果相似（女性调整后的危险比：0.90[95%置信区间：0.54 至 1.51]；男性调整后的危险比：0.76[95%置信区间：0.56 至 1.02]；p 交互=0.952）。

结论

在复杂冠状动脉疾病患者中，女性性别不是 10 年死亡率的独立预测因素。在 5 年时观察到的 PCI 或 CABG 治疗与性别之间的交互作用在 10 年时不再存在。（经皮冠状动脉介入治疗与紫杉醇协同作用及心脏手术：SYNTAX 扩展生存[SYNTAXES]，NCT03417050；SYNTAX 研究：紫杉醇药物洗脱支架与冠状动脉旁路移植术治疗狭窄血管[SYNTAX]，NCT00114972）。