Research Department, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, North Midlands, UK.
Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, North Midlands, UK.
Catheter Cardiovasc Interv. 2022 Feb;99(2):447-456. doi: 10.1002/ccd.30081. Epub 2022 Jan 18.
To assess sex-based differences in clinical outcomes following complex and high-risk but indicated percutaneous coronary intervention (CHiP).
CHiP is increasingly common in contemporary percutaneous coronary intervention (PCI) practice. Data on sex differences in the type of CHiP procedures undertaken or their associated clinical outcomes are limited.
Patients with stable coronary artery disease who underwent CHiP between January 1, 2006, and December 31, 2017, were included. All procedures were stratified by sex. Multivariate logistic regression analyses were performed to investigate the sex-specific adjusted odds ratios (aOR) of in-hospital outcomes.
Out of 424,290 PCI procedures, 141,610 (33.37%) were CHiP procedures. Overall, 32,129 (23%) of CHiP were undertaken in females. Females were older than males (median: 74.8 vs. 69.1 years). Males had a higher prevalence of previous myocardial infarction (MI) (44.6% vs. 35.6%) and previous PCI (40% vs. 32.5%). The most common variable observed in female patients undergoing CHiP was age >80 (35.4%), followed by prior coronary artery bypass graft (CABG) (24.3%) and severe coronary calcification (22.6%). In contrast, the most common variable in male patients was prior CABG (36%), followed by chronic thrombus occlusion (CTO) PCI (34.4%) and severe coronary calcification (22%). Females had higher odds (aOR) for mortality (aOR: 1.78, 95% CI: [1.4, 2.2]), bleeding (aOR: 1.99, 95% CI: [1.72, 3.2]), and major adverse cardiovascular and cerebral events (aOR: 1.23, 95% CI: [1.09, 1.38]) compared to males.
In this national analysis of CHiP procedures over 12 years, there were significant sex differences in the type of CHiP procedures undertaken, with females at increased odds for mortality and in-hospital adverse outcomes.
评估复杂高危且适应证明确的经皮冠状动脉介入治疗（CHiP）后的性别差异。
CHiP 在当代经皮冠状动脉介入治疗（PCI）实践中越来越常见。关于接受的 CHiP 手术类型或其相关临床结局的性别差异的数据有限。
纳入 2006 年 1 月 1 日至 2017 年 12 月 31 日期间接受 CHiP 的稳定型冠状动脉疾病患者。所有手术均按性别分层。采用多变量逻辑回归分析研究院内结局的性别特异性调整比值比（aOR）。
在 424290 例 PCI 手术中，141610 例（33.37%）为 CHiP 手术。总体而言，32129 例（23%）的 CHiP 在女性中进行。女性比男性年龄大（中位数：74.8 岁 vs. 69.1 岁）。男性既往心肌梗死（MI）（44.6% vs. 35.6%）和既往 PCI（40% vs. 32.5%）的患病率更高。在接受 CHiP 的女性患者中最常见的变量是年龄>80 岁（35.4%），其次是既往冠状动脉旁路移植术（CABG）（24.3%）和严重冠状动脉钙化（22.6%）。相比之下，男性患者中最常见的变量是既往 CABG（36%），其次是慢性血栓闭塞性病变（CTO）PCI（34.4%）和严重冠状动脉钙化（22%）。与男性相比，女性发生死亡率（aOR：1.78，95%CI：[1.4, 2.2]）、出血（aOR：1.99，95%CI：[1.72, 3.2]）和主要不良心脑血管事件（aOR：1.23，95%CI：[1.09, 1.38]）的比值更高。
在这项为期 12 年的 CHiP 手术的全国性分析中，CHiP 手术类型存在显著的性别差异，女性的死亡率和院内不良结局发生率更高。
