Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
London Health Science Centre, London, ON, Canada.
Mayo Clin Proc. 2021 Jul;96(7):1845-1860. doi: 10.1016/j.mayocp.2020.11.031.
To evaluate the effects of female sex on in-hospital outcomes and to provide estimates for sex-specific prediction models of adverse outcomes following left atrial appendage closure (LAAC).
Cohort-based observational study querying the National Inpatient Sample database between October 1, 2015, and December 31, 2017. Demographics, baseline characteristics, and comorbidities were assessed with the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index score (ECS), and CHADS-VASc score. The primary outcome was in-hospital major adverse events (MAEs) defined as the composite of bleeding, vascular, cardiac complications, post-procedural stroke, and acute kidney injury. The associations of the CCI, ECS, and CHADS-VASc score with in-hospital MAE were examined using logistic regression models for women and men, respectively.
A total of 3294 hospitalizations were identified, of which 1313 (40%) involved women and 1981 (60%) involved men. Women were older (76.3±7.7 vs 75.2±8.4 years, P<.001), had a higher CHADS-VASc score (4.9±1.4 vs 3.9±1.4, P<.001) but showed lower CCI and ECS compared with men (2.1±1.9 vs 2.3±1.9, P=.01; and 9.3±5.9 vs 9.9±5.7, P=.002, respectively). The primary composite outcome occurred in 4.6% of patients and was higher in women compared with men (women 5.6% vs men 4.0%, P=.04), and this was mainly driven by the occurrence of cardiac complications (2.4% vs 1.2%, P=.01). In women, older age, higher median income, and higher CCI (adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.21 to 1.44; P<.001), ECS (aOR, 1.04; 95% CI, 1.02 to 1.07; P=.002), and CHADS-VASc score (aOR, 1.24; 95% CI, 1.10 to 1.39; P<.001) were associated with increased risk of in-hospital MAE. In men, non-White race/ethnicity, lower median income, and higher ECS (aOR, 1.06; 95% CI, 1.04 to 1.09; P<.001) were associated with increased risk of in-hospital MAE.
Women had higher rates of in-hospital adverse events following LAAC than men did. Women with older age and higher median income, CCI, ECS, and CHADS-VASc scores were associated with in-hospital adverse events, whereas men with non-White race/ethnicity, lower median income, and higher ECS were more likely to experience adverse events. Further research is warranted to identify sex-specific, racial/ethnic, and socioeconomic pathways during the patient selection process to minimize complications in patients undergoing LAAC.
评估女性性别对住院结局的影响，并提供左心耳封堵术（LAAC）后不良结局的性别特异性预测模型的估计值。
本研究基于队列的观察性研究，在 2015 年 10 月 1 日至 2017 年 12 月 31 日期间，查询了国家住院患者样本数据库。使用 Charlson 合并症指数（CCI）、Elixhauser 合并症指数评分（ECS）和 CHADS-VASc 评分评估人口统计学、基线特征和合并症。主要结局是住院期间的主要不良事件（MAE），定义为出血、血管、心脏并发症、术后中风和急性肾损伤的综合事件。使用逻辑回归模型分别评估 CCI、ECS 和 CHADS-VASc 评分与女性和男性住院 MAE 的相关性。
共确定了 3294 例住院患者，其中 1313 例（40%）为女性，1981 例（60%）为男性。女性年龄更大（76.3±7.7 岁比 75.2±8.4 岁，P<.001），CHADS-VASc 评分更高（4.9±1.4 比 3.9±1.4，P<.001），但与男性相比，CCI 和 ECS 较低（2.1±1.9 比 2.3±1.9，P=.01；9.3±5.9 比 9.9±5.7，P=.002）。主要复合结局在 4.6%的患者中发生，女性发生率高于男性（女性 5.6%比男性 4.0%，P=.04），这主要是由于心脏并发症的发生（2.4%比 1.2%，P=.01）。在女性中，年龄较大、中位收入较高和 CCI 较高（调整后的优势比[aOR]，1.32；95%置信区间[CI]，1.21 至 1.44；P<.001）、ECS（aOR，1.04；95%CI，1.02 至 1.07；P=.002）和 CHADS-VASc 评分（aOR，1.24；95%CI，1.10 至 1.39；P<.001）与住院 MAE 风险增加相关。在男性中，非白种人/族裔、较低的中位收入和较高的 ECS（aOR，1.06；95%CI，1.04 至 1.09；P<.001）与住院 MAE 风险增加相关。
女性在接受 LAAC 后住院期间不良事件的发生率高于男性。年龄较大、中位收入较高、CCI、ECS 和 CHADS-VASc 评分较高的女性与住院不良事件相关，而中位收入较低、非白种人/族裔和 ECS 较高的男性更有可能经历不良事件。需要进一步研究，以确定患者选择过程中的性别特异性、种族/族裔和社会经济途径，以尽量减少接受 LAAC 的患者的并发症。
