Díez-Villanueva Pablo, García-Acuña Jose María, Raposeiras-Roubin Sergio, Barrabés Jose A, Cordero Alberto, Martínez-Sellés Manuel, Bardají Alfredo, Marín Francisco, Ruiz-Nodar Juan M, Vicente-Ibarra Nuria, Alonso Salinas Gonzalo L, Cid-Alvárez Belén, Abu Assi Emad, Formiga Frances, Núñez Julio, Núñez Eduardo, Ariza-Solé Albert, Sanchis Juan
Servicio de Cardiología, Hospital Universitario La Princesa, 28006 Madrid, Spain.
Servicio de Cardiología, Hospital Clínico Universitario de Santiago, CIBERCV, 15706 Santiago de Compostela, A Coruña, Spain.
J Clin Med. 2021 Sep 26;10(19):4403. doi: 10.3390/jcm10194403.
Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, < 0.001) and more often had a history of hypertension (77% vs. 83.1%, < 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men ( < 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, = 0.035), and there was a significant interaction between sex and DM ( = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18-1.78; < 0.001), but not in men (HR: 0.98, 95% CI = 0.84-1.14; = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men.
迄今为止，很少有研究探讨性别与糖尿病（DM）在老年非ST段抬高型急性冠状动脉综合征（NSTEACS）患者预后中的相互作用。我们的目的是根据性别探讨DM在未选择的老年NSTEACS患者预后中的作用。对11个西班牙NSTEACS登记处进行了回顾性分析，纳入年龄≥70岁的患者。主要终点是一年全因死亡率。共纳入7211例患者，其中2770例（38.4%）为女性，39.9%患有DM。与男性相比，女性年龄更大（79.95±5.75岁 vs. 78.45±5.43岁，<0.001），且更常有高血压病史（77% vs. 83.1%，<0.01）。贫血和慢性肾脏病在女性中都更常见。另一方面，她们既往有动脉硬化性心血管疾病或合并症（如外周动脉疾病和慢性肺病）的频率较低。女性入院时临床情况较差，不过男性更常采用侵入性治疗方法和进行院内血管重建（<0.001）。在一年的随访中，1090例患者（15%）死亡，男女之间无差异。男性是死亡率的独立预测因素（HR = 1.15，95%CI 1.01至1.32，= 0.035），性别与DM之间存在显著相互作用（= 0.002）。DM与女性死亡率密切相关（HR：1.45，95%CI = 1.18 - 1.78；<0.001），但与男性死亡率无关（HR：0.98，95%CI = 0.84 - 1.14；= 0.787）。总之，DM与老年NSTEACS女性患者的死亡率相关，但与男性无关。
