复杂经皮冠状动脉介入治疗后的性别差异
Sex related disparities after complex percutaneous coronary interventions.
作者信息
Alperi Alberto, Almendárez Marcel, Pascual Isaac, Alvarez Rut, Betanzos Jose Luis, Hernández-Vaquero Daniel, Ptaszynski Raul, Ortiz Juan Francisco, Moris Cesar, Avanzas Pablo
机构信息
Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain.
Department of Cardiology, Health Research Institute of Asturias (Instituto de Iinvestigación Sanitaria del Principado de Asturias), Oviedo, Spain.
出版信息
Front Cardiovasc Med. 2024 Nov 7;11:1382585. doi: 10.3389/fcvm.2024.1382585. eCollection 2024.
INTRODUCTION
Complex Percutaneous coronary intervention (PCI) for the treatment of ischemic heart disease has increased significantly. We aimed to evaluate sex-related differences in patients undergoing complex PCI.
METHODS
single-center prospective observational study including patients undergoing complex PCI between 2017 and 2023. Baseline and procedural features, and mid-term outcomes were compared according to the gender distribution. The combined primary endpoint included stroke, myocardial infarction, need for a new coronary revascularization, and all-cause mortality. Propensity score (PS) matching with an inverse probability of treatment weight (IPW) approach was used to adjust for differences in baseline characteristics.
RESULTS
1,283 patients were included, 983 (76.6%) male and 300 (23.4%) female. Median follow-up was 2.4 (IQR: 1-3.8) years. There was a higher rate of no-reflow phenomenon (4% vs. 1.8%, = 0.03) among female patients. In the overall cohort, female patients had a greater risk for the combined primary endpoint (HR 1.28, 95% CI: 1.02-1.59). In the matched cohort, female patients exhibited a higher risk for the combined primary endpoint (HR 1.23, 95% CI: 1.06-1.42), as well as for myocardial infarction (HR 1.34, 95% CI 1.03-1.75), and all-cause mortality (HR 1.21, 95% CI 1.02-1.45), and a trend towards a higher risk for the need of a new coronary revascularization (HR 1.22, 95% CI 0.92-1.61).
CONCLUSIONS
in a contemporary cohort of patients undergoing complex PCI procedures, female patients are associated with a higher risk of early complications.
引言
用于治疗缺血性心脏病的复杂经皮冠状动脉介入治疗（PCI）显著增加。我们旨在评估接受复杂PCI患者的性别差异。
方法
单中心前瞻性观察性研究，纳入2017年至2023年间接受复杂PCI的患者。根据性别分布比较基线和手术特征以及中期结局。联合主要终点包括中风、心肌梗死、需要进行新的冠状动脉血运重建以及全因死亡率。采用倾向评分（PS）匹配和治疗权重逆概率（IPW）方法来调整基线特征的差异。
结果
共纳入1283例患者，其中男性983例（76.6%），女性300例（23.4%）。中位随访时间为2.4年（四分位间距：1 - 3.8年）。女性患者无复流现象发生率较高（4%对1.8%，P = 0.03）。在整个队列中，女性患者发生联合主要终点的风险更高（风险比[HR] 1.28，95%置信区间[CI]：1.02 - 1.59）。在匹配队列中，女性患者发生联合主要终点的风险更高（HR 1.23，95% CI：1.06 - 1.42），心肌梗死风险（HR 1.34，95% CI 1.03 - 1.75）以及全因死亡率风险（HR 1.21，95% CI 1.02 - 1.45）也更高，并且有进行新的冠状动脉血运重建需求风险更高的趋势（HR 1.22，95% CI 0.92 - 1.61）。
结论
在当代接受复杂PCI手术的患者队列中，女性患者早期并发症风险较高。
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