Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3004, Australia.
Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research & Education in Therapeutics, Monash University, Clayton, Victoria 3800, Australia.
Eur Heart J Qual Care Clin Outcomes. 2022 Jun 6;8(4):420-428. doi: 10.1093/ehjqcco/qcab007.
We sought to investigate if sex disparity exists for secondary prevention pharmacotherapy following acute coronary syndrome (ACS) and impact on long-term clinical outcomes.
We analysed data on medical management 30-day post-percutaneous coronary intervention (PCI) for ACS in 20 976 patients within the multicentre Melbourne Interventional Group registry (2005-2017). Optimal medical therapy (OMT) was defined as five guideline-recommended medications, near-optimal medical therapy (NMT) as four medications, sub-optimal medical therapy (SMT) as ≤3 medications. Overall, 65% of patients received OMT, 27% NMT and 8% SMT. Mean age was 64 ± 12 years; 24% (4931) were female. Women were older (68 ± 12 vs. 62 ± 12 years) and had more comorbidities. Women were less likely to receive OMT (61% vs. 66%) and more likely to receive SMT (10% vs. 8%) compared to men, P < 0.001. On long-term follow-up (median 5 years, interquartile range 2-8 years), women had higher unadjusted mortality (20% vs. 13%, P < 0.001). However, after adjusting for medical therapy and baseline risk, women had lower long-term mortality [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.79-0.98; P = 0.02]. NMT (HR 1.17, 95% CI 1.05-1.31; P = 0.004) and SMT (HR 1.79, 95% CI 1.55-2.07; P < 0.001) were found to be independent predictors of long-term mortality.
Women are less likely to be prescribed optimal secondary prevention medications following PCI for ACS. Lower adjusted long-term mortality amongst women suggests that as well as baseline differences between gender, optimization of secondary prevention medical therapy amongst women can lead to improved outcomes. This highlights the need to focus on minimizing the gap in secondary prevention pharmacotherapy between sexes following ACS.
我们旨在探究急性冠状动脉综合征（ACS）后二级预防药物治疗是否存在性别差异，以及其对长期临床结局的影响。
我们分析了多中心墨尔本介入组注册研究（2005-2017 年）中 20976 例经皮冠状动脉介入治疗（PCI）后 30 天的 ACS 患者的医疗管理数据。最佳药物治疗（OMT）定义为使用 5 种指南推荐的药物，接近最佳药物治疗（NMT）为使用 4 种药物，药物治疗不足（SMT）为使用 ≤3 种药物。总体而言，65%的患者接受 OMT，27%的患者接受 NMT，8%的患者接受 SMT。平均年龄为 64±12 岁；24%（4931 人）为女性。女性年龄较大（68±12 岁 vs. 62±12 岁），合并症更多。与男性相比，女性接受 OMT 的可能性较低（61% vs. 66%），接受 SMT 的可能性较高（10% vs. 8%），P<0.001。在长期随访（中位随访时间为 5 年，四分位距为 2-8 年）中，女性的未调整死亡率更高（20% vs. 13%，P<0.001）。然而，在校正药物治疗和基线风险后，女性的长期死亡率较低[风险比（HR）0.88，95%置信区间（CI）0.79-0.98；P=0.02]。发现 NMT（HR 1.17，95%CI 1.05-1.31；P=0.004）和 SMT（HR 1.79，95%CI 1.55-2.07；P<0.001）是长期死亡率的独立预测因素。
女性在接受 ACS 后行 PCI 治疗后，接受最佳二级预防药物治疗的可能性较低。女性调整后的长期死亡率较低表明，除了性别之间的基线差异外，优化女性二级预防药物治疗可以改善结局。这突显了需要关注的问题是，ACS 后应尽量缩小男女之间二级预防药物治疗的差距。
