Dewidar Omar, Dawit Haben, Barbeau Victoria, Birnie David, Welch Vivian, Wells George A
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
CJC Open. 2021 Sep 9;4(1):75-84. doi: 10.1016/j.cjco.2021.09.003. eCollection 2022 Jan.
Evidence from randomized trials is conflicting on the effects of cardiac resynchronization therapy (CRT) by sex, and differences in access are unknown. We examined sex differences in the implantation rates and outcomes in patients treated with CRT using cohort studies.
We followed a pre-specified protocol (International Prospective Register of Systematic Reviews [PROSPERO]: CRD42020204804). MEDLINE, Embase, and Web of Science were searched for cohort studies from January 2000 to June 2020 that evaluated the response to CRT in patients ≥ 18 years old and reported sex-specific information in any language.
We included 97 studies (1,172,654 men and 486,553 women). Men received CRT more frequently than women (median ratio, 3.16; 25th to 75th interquartile range, 2.48-3.62). In the unadjusted analysis, men had a greater long-term all-cause mortality rate after CRT, compared with women (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.38-1.63; < 0.001). Adjustment for confounders did not affect the strength or direction of association (HR, 1.45; 95% CI, 1.32-1.59; < 0.001). Women achieved a greater rate of improvement in left ejection fraction compared with men (HR, 4.66; 95% CI, 4.23-5.13; < 0.001). Men had a lower risk of a pneumothorax (relative risk, 0.21; 95% CI, 0.13-0.34; < 0.001]); otherwise, there were no differences in complications.
We found in this large meta-analysis that men were more often implanted with CRT than women, yet men had a higher long-term all-cause mortality following CRT, compared with women, and smaller improvement in left ventricular ejection fraction. Reasons for this difference in implantation rates of CRT in real-world practice need to be investigated.
随机试验的证据显示，心脏再同步治疗（CRT）的效果在性别上存在矛盾，且在治疗机会方面的差异尚不清楚。我们通过队列研究来探究接受CRT治疗的患者在植入率和治疗结果方面的性别差异。
我们遵循预先指定的方案（国际系统评价前瞻性注册库[PROSPERO]：CRD42020204804）。检索了MEDLINE、Embase和Web of Science数据库，查找2000年1月至2020年6月期间评估18岁及以上患者对CRT反应并以任何语言报告了性别特异性信息的队列研究。
我们纳入了97项研究（1,172,654名男性和486,553名女性）。男性接受CRT的频率高于女性（中位数比值为3.16；第25至75百分位数区间为2.48 - 3.62）。在未调整分析中，与女性相比，男性在接受CRT后的长期全因死亡率更高（风险比[HR]为1.50；95%置信区间[CI]为1.38 - 1.63；P < 0.001）。对混杂因素进行调整并未影响关联的强度或方向（HR为1.45；95% CI为1.32 - 1.59；P < 0.001）。与男性相比，女性左心室射血分数的改善率更高（HR为4.66；95% CI为4.23 - 5.13；P < 0.001）。男性发生气胸的风险较低（相对风险为0.21；95% CI为0.13 - 0.34；P < 0.001）；除此之外，并发症方面没有差异。
我们在这项大型荟萃分析中发现，男性接受CRT植入的频率高于女性，但与女性相比，男性在接受CRT后的长期全因死亡率更高，且左心室射血分数的改善较小。现实世界中CRT植入率存在这种差异的原因需要进一步研究。
