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急性心肌梗死合并冠状动脉旁路移植术(CABG)病史患者经皮冠状动脉介入治疗(PCI)后院内结局的性别差异:一项横断面研究。

Sex Disparities in In-Hospital Outcomes After Percutaneous Coronary Intervention (PCI) in Patients With Acute Myocardial Infarction and a History of Coronary Artery Bypass Grafting (CABG): A Cross-Sectional Study.

作者信息

Yan Rui, Zhang Hui, Shi Bo, Ye Congyan, Fu Shizhe, Wang Kairu, Yang Jie, Yan Ru, Jia Shaobin, Ma Xueping, Cong Guangzhi

机构信息

Institute of Medical Sciences, General Hospital of Ningxia Medical University Yinchuan Ningxia China.

School of Clinical Medicine Ningxia Medical University Yinchuan Ningxia China.

出版信息

Health Sci Rep. 2024 Dec 19;7(12):e70292. doi: 10.1002/hsr2.70292. eCollection 2024 Dec.

Abstract

BACKGROUND AND AIMS

The role of sex disparities in in-hospital outcomes after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in patients with a history of coronary artery bypass grafting (CABG) remains underexplored. This study aimed to identify sex disparities in in-hospital outcomes after PCI in patients with AMI and a history of CABG.

METHODS

Using the National Inpatient Sample database, we identified patients hospitalized for AMI with a history of CABG who underwent PCI between 2016 and 2019. 1:1 propensity score matching was used to minimize standardized mean differences of baseline variables and compare in--hospital outcomes.

RESULTS

In total, 75,185 weighted hospitalizations of patients were identified. Compared with male patients, female patients exhibited elevated risks of in-hospital mortality (3.72% vs. 2.85%; adjusted odds ratio [aOR] 1.48; 95% confidence interval [CI] 1.14-1.93), major adverse cardiac or cerebrovascular events (MACCEs) (4.96% vs. 3.75%; aOR 1.46; 95% CI 1.18-1.82), bleeding (4.91% vs. 3.01%; aOR 1.56; 95% CI 1.27-1.79), and longer length of stay (4.64 days vs. 3.96 days; 0.42; 95% CI 0.28-0.55). After propensity matching, female patients remained associated with increased risks of in-hospital mortality (3.81% vs. 2.81%; aOR 1.37; 95% CI 1.06-1.78), MACCEs (5.08% vs. 3.84%; aOR 1.35; 95% CI 1.08-1.70), bleeding (5.03% vs. 3.11%; aOR 1.57; 95% CI 1.24-2.00), and longer length of stay (4.61 ± 4.76 days vs. 4.06 ± 4.10 days; 0.39; 95% CI 0.18-0.59). Female patients aged > 60 years were more vulnerable to in-hospital mortality than were their male counterparts (3.06% vs. 4.15%; aOR 1.56; 95% CI 1.18-2.05).

CONCLUSIONS

Female patients who underwent PCI for AMI with a history of CABG had higher risks of in-hospital mortality, MACCEs, bleeding, and longer length of stay, with in-hospital mortality rates being particularly pronounced among older patients.

摘要

背景与目的

冠状动脉旁路移植术(CABG)病史患者经皮冠状动脉介入治疗(PCI)后住院结局中的性别差异作用仍未得到充分研究。本研究旨在确定有CABG病史的急性心肌梗死(AMI)患者PCI后住院结局中的性别差异。

方法

利用全国住院样本数据库,我们确定了2016年至2019年间因AMI住院且有CABG病史并接受PCI的患者。采用1:1倾向评分匹配以最小化基线变量的标准化均数差异并比较住院结局。

结果

总共确定了75185例加权住院患者。与男性患者相比,女性患者住院死亡率风险升高(3.72%对2.85%;调整优势比[aOR]1.48;95%置信区间[CI]1.14 - 1.93)、主要不良心脏或脑血管事件(MACCEs)(4.96%对3.75%;aOR 1.46;95% CI 1.18 - 1.82)、出血(4.91%对3.01%;aOR 1.56;95% CI 1.27 - 1.79)以及住院时间更长(4.64天对3.96天;0.42;95% CI 0.28 - 0.55)。倾向匹配后,女性患者仍与住院死亡率风险增加相关(3.81%对2.81%;aOR 1.37;95% CI 1.06 - 1.78)、MACCEs(5.08%对3.84%;aOR 1.35;95% CI 1.08 - 1.70)、出血(5.03%对3.11%;aOR 1.57;95% CI 1.24 - 2.00)以及住院时间更长(4.61±4.76天对4.06±4.10天;0.39;95% CI 0.18 - 0.59)。年龄>60岁的女性患者比男性患者更容易发生住院死亡(3.06%对4.15%;aOR 1.56;95% CI 1.18 - 2.05)。

结论

有CABG病史的AMI患者接受PCI后,女性患者住院死亡率、MACCEs、出血风险更高且住院时间更长,老年患者的住院死亡率尤为明显。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2edb/11659193/c83135e39869/HSR2-7-e70292-g002.jpg

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