Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Vasc Med. 2020 Dec;25(6):541-548. doi: 10.1177/1358863X20964577. Epub 2020 Nov 17.
While the presence of gender disparities in cardiovascular disease have been described, there is a paucity of data regarding the impact of sex in acute pulmonary embolism (PE). We identified all patients admitted to a tertiary care hospital with acute PE between August 1, 2012 through July 1, 2018. We stratified the presenting characteristics, management, and outcomes between women and men. Of the 2031 patients admitted with acute PE, 1081 (53.2%) were women. Women were more likely to present with dyspnea (59.8% vs 52.0%, < 0.001) and less likely to present with hemoptysis (1.9% vs 4.0%, = 0.01). Women were older (63.8 ± 17.4 years vs 62.3 ± 15.0 years, = 0.04), but had lower rates of myocardial infarction, liver disease, smoking history, and prior DVT. PE severity was similar between women and men (massive: 4.9% vs 3.6%; submassive: 43.9% vs 41.8%; = 0.19), yet women were more likely to present with normal right ventricular size on a surface echocardiogram (63.2% vs 54.8%, = 0.01). In unadjusted analyses, women were less likely to survive to discharge (92.4% vs 94.7%, = 0.04), but after adjustment, there was no sex-based survival difference. There were no sex differences in the PE-related diagnostic studies performed, use of advanced therapies, or short-term outcomes, before and after adjustment ( > 0.05 for all). In this large PE cohort from a tertiary care institution, women had different comorbidity profiles and PE presentations compared with men. Despite these differences, there were no sex disparities in PE management or outcomes.
虽然已经描述了心血管疾病中存在的性别差异，但关于急性肺栓塞 (PE) 中性别影响的数据很少。我们确定了 2012 年 8 月 1 日至 2018 年 7 月 1 日期间在一家三级保健医院因急性 PE 住院的所有患者。我们对女性和男性的临床表现、治疗和结局进行了分层。在 2031 例急性 PE 患者中，1081 例（53.2%）为女性。女性更可能出现呼吸困难（59.8% vs 52.0%，<0.001），而咯血的可能性较小（1.9% vs 4.0%，= 0.01）。女性年龄较大（63.8±17.4 岁 vs 62.3±15.0 岁，= 0.04），但心肌梗死、肝病、吸烟史和既往 DVT 发生率较低。PE 严重程度在女性和男性之间相似（大面积：4.9% vs 3.6%；次大面积：43.9% vs 41.8%；= 0.19），但女性在体表超声心动图上更可能出现右心室大小正常（63.2% vs 54.8%，= 0.01）。在未调整分析中，女性出院时的生存率较低（92.4% vs 94.7%，= 0.04），但调整后，性别间无生存差异。在调整前后（所有均>0.05），PE 相关诊断研究、高级治疗的使用或短期结局均无性别差异。在这家三级保健机构的大型 PE 队列中，女性与男性相比具有不同的合并症谱和 PE 表现。尽管存在这些差异，但在 PE 的管理或结局方面没有性别差异。
