Newman Joshua, Bruno Elizabeth, Allen Sorcha, Moore Jonathan, Zilinyi Robert, Khaliq Asma, Alkhafan Fahad, Vitarello Clara, Lookstein Robert, Keeling Brent, Michael Gibson C, Rosenfield Kenneth, Secemsky Eric A, Rosovsky Rachel P, Darki Amir
Department of Medicine, Division of Cardiology, Loyola University Medical Center, Maywood, IL, USA.
Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, MI, USA.
Vasc Med. 2025 Feb;30(1):67-75. doi: 10.1177/1358863X241281872. Epub 2024 Sep 12.
Pulmonary embolism (PE) is the third-leading cause of cardiovascular mortality, accounting for 100,000 deaths per year in the United States. Although sex-based disparities have previously been described in this population, it is unclear if these differences have persisted with the expansion of PE evaluation and treatment approaches. The purpose of this study is to investigate sex-based differences in the evaluation, management, and outcomes of patients with acute PE.
We performed a retrospective analysis of patients enrolled in the national Pulmonary Embolism Response Team (PERT) Consortium database between October 2015 and October 2022. We evaluated patient demographics, clinical characteristics, diagnostic imaging performed, treatment at several phases of care (pre-PERT, PERT recommendations, and post-PERT), and clinical outcomes.
A total of 5722 patients with acute PE (2838 [49.6%] women) from 35 centers were included. There were no differences in PE risk category between male and female patients. Women were less likely to undergo echocardiography (76.9% vs 73.8%) and more likely to receive no anticoagulation prior to PERT evaluation (35.5% vs 32.9%). PERT teams were more likely to recommend catheter-based interventions for men (26.6% vs 23.1%), and men were more likely to undergo these procedures (21.9% vs 19.3%). In a multivariable analysis, female sex was a predictor of in-hospital mortality (OR 1.53, 95% CI 1.06 to 2.21).
In this analysis, we identified sex-based differences in the evaluation and management of patients presenting with acute PE. Subsequently, women presenting with acute PE were at higher risk of in-hospital mortality.
肺栓塞（PE）是心血管疾病死亡的第三大原因，在美国每年导致10万人死亡。尽管此前已描述过该人群中基于性别的差异，但尚不清楚随着PE评估和治疗方法的扩展，这些差异是否仍然存在。本研究的目的是调查急性PE患者在评估、管理和结局方面的性别差异。
我们对2015年10月至2022年10月期间纳入国家肺栓塞反应团队（PERT）联盟数据库的患者进行了回顾性分析。我们评估了患者的人口统计学特征、临床特征、进行的诊断性影像学检查、护理各阶段（PERT前、PERT建议和PERT后）的治疗情况以及临床结局。
共纳入了来自35个中心的5722例急性PE患者（2838例[49.6%]为女性）。男性和女性患者在PE风险类别上没有差异。女性接受超声心动图检查的可能性较小（76.9%对73.8%），在PERT评估前未接受抗凝治疗的可能性较大（35.5%对32.9%）。PERT团队更有可能建议对男性进行基于导管的干预（26.6%对23.1%），男性接受这些手术的可能性也更大（21.9%对19.3%）。在多变量分析中，女性是住院死亡率的预测因素（OR 1.53，95%CI 1.06至2.21）。
在本分析中，我们确定了急性PE患者在评估和管理方面的性别差异。随后，急性PE女性患者的住院死亡风险更高。
