非心脏手术后心肌损伤的性别差异及术后死亡率

Sex differences in myocardial injury after non-cardiac surgery and postoperative mortality.

作者信息

Kwon Ji-Hye, Park Jungchan, Lee Seung-Hwa, Hyun Cheol Won, Kim Jihoon, Yang Kwangmo, Min Jeong Jin, Lee Jong Hwan, Lee Sangmin Maria, Choi Jin-Ho, Lee Sang-Chol, Gwon Hyeon-Cheol, Her Sukyoung, Kim Kyunga, Ahn Joonghyun

机构信息

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Wiltse Memorial Hospital, Suwon, South Korea.

出版信息

Perioper Med (Lond). 2023 Mar 16;12(1):7. doi: 10.1186/s13741-023-00294-3.

DOI:10.1186/s13741-023-00294-3

PMID:36927786

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10018929/

Abstract

BACKGROUND

Myocardial injury after non-cardiac surgery (MINS) has recently been accepted as a predictor of mortality. However, sex differences in the incidence of MINS and survival thereafter are not fully understood. This study aimed to compare the incidence of MINS and mortality among male and female patients.

METHODS

This single-center study was conducted using the database of a large tertiary referral hospital. Consecutive patients with cardiac troponin (cTn) detected within 30 days after non-cardiac surgery performed between January 2010 and June 2019 were grouped according to sex. The incidence of MINS and mortality of patients with MINS were compared between men and women.

RESULTS

Of the 33,311 patients, 18,546 (55.7%) were men and 14,765 (44.3%) were women. In a multivariable analysis, women showed a significantly lower incidence of MINS than did men (17.9% vs. 14.2%; odds ratio, 0.76; 95% confidence interval [CI], 0.71-0.81; P < 0.001). In patients with MINS, the propensity-score-matched analysis showed that 30-day mortality did not differ according to sex, but mortality in females was significantly lower than that in males during the overall follow-up (33.0% vs. 25.7%; hazard ratio, 0.75; 95% CI, 0.66-0.84; P < 0.001).

CONCLUSION

The incidence of MINS was lower in women than in men. In patients with MINS, female sex may be associated with a survival benefit. Further studies are needed to confirm these findings.

摘要

背景

非心脏手术后心肌损伤（MINS）最近已被公认为死亡率的预测指标。然而，MINS发病率及后续生存率的性别差异尚未完全明确。本研究旨在比较男性和女性患者中MINS的发病率及死亡率。

方法

本单中心研究使用了一家大型三级转诊医院的数据库。将2010年1月至2019年6月期间非心脏手术后30天内检测到心肌肌钙蛋白（cTn）的连续患者按性别分组。比较男性和女性患者中MINS的发病率及MINS患者的死亡率。

结果

在33311例患者中，男性18546例（55.7%），女性14765例（44.3%）。多变量分析显示，女性MINS的发病率显著低于男性（17.9%对14.2%；比值比，0.76；95%置信区间[CI]，0.71 - 0.81；P < 0.001）。在MINS患者中，倾向得分匹配分析显示，30天死亡率无性别差异，但在整个随访期间，女性死亡率显著低于男性（33.0%对25.7%；风险比，0.75；95% CI，0.66 - 0.84；P < 0.001）。