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左主干分叉病变行单支架或双支架治疗后临床结局的性别差异。

Gender-related differences in clinical outcomes after either single or double left main bifurcation stenting.

机构信息

Division of Cardiology, Department of Specialistic Medicine, Rovigo General Hospital, Viale Tre Martiri 140, 45100, Rovigo, Italy.

Department of Translational Medicine, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy.

出版信息

Heart Vessels. 2022 Aug;37(8):1326-1336. doi: 10.1007/s00380-022-02038-7. Epub 2022 Feb 18.

Abstract

We sought to examine the impact of gender differences in clinical outcomes at 3 years also comparing the role of double versus single stenting approach for the treatment of coronary unprotected LM bifurcation lesions. We retrospectively analyzed both the procedural and medical data of patients referred to our hub center for complex LM bifurcation disease, treated using Crossover provisional stenting, T or T-and-Protrusion (TAP), Culotte, and Nano-inverted-T (NIT) techniques between January 1st, 2008 and May 1st 2018. The main outcome of the study was to evaluate the association between gender and target lesion failure (TLF) based on the different stenting technique used. Five hundred and sixty-seven patients (251 females, mean age 70.0 ± 10 years, mean Syntax score 31.6 ± 6.3) were evaluated. Crossover, T or TAP, culotte and NIT techniques were performed in 171 (30.1%), 61 (10.7%), 98 (17.2%) and 237 (41.8%) patients, respectively with no differences in baseline and peri-procedural items among gender. At a mean follow-up of 37.1 ± 10.8 months (range 22.1-39.3 moths), the overall TLF rate, cardiovascular mortality and stent thrombosis were 12.1%, 3.1% and 1.0%, respectively. Female gender was associated with an increased rate of major bleeding when treated with double stent strategy (p = 0.02). No gender difference in TLF was noted among gender, independently from the stenting approach used. Among patients with ULM bifurcation disease undergoing PCI, TLF rates were not different between genders at 3-year follow-up either using a single or double stent technique.

摘要

我们旨在探讨 3 年临床结果中的性别差异,并比较经皮冠状动脉介入治疗(PCI)中,对冠状动脉无保护左主干(LM)分叉病变时,使用双支架与单支架策略的作用。我们回顾性分析了 2008 年 1 月 1 日至 2018 年 5 月 1 日期间,在我们的中心因复杂 LM 分叉病变而行 Crossover 预扩张支架术、T 或 T-and-Protrusion(TAP)、靴型和 Nano-inverted-T(NIT)治疗的患者的手术和医疗数据。研究的主要结果是评估不同支架技术应用下,性别与靶病变失败(TLF)之间的相关性。共评估了 567 例患者(251 例女性,平均年龄 70.0±10 岁,平均 Syntax 评分 31.6±6.3)。171 例(30.1%)、61 例(10.7%)、98 例(17.2%)和 237 例(41.8%)患者分别接受了 Crossover、T 或 TAP、靴型和 NIT 技术,性别之间在基线和围手术期项目上没有差异。平均随访 37.1±10.8 个月(范围 22.1-39.3 个月),总的 TLF 率、心血管死亡率和支架血栓形成率分别为 12.1%、3.1%和 1.0%。在接受双支架策略治疗时,女性的大出血发生率更高(p=0.02)。在使用支架策略时,性别与 TLF 之间无相关性。在接受 PCI 治疗的 ULM 分叉病变患者中,无论使用单支架还是双支架技术,3 年随访时,TLF 率在性别之间没有差异。

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