接受冠状动脉造影的未筛选患者中的性别差异与预后

Sex-Based Differences and Outcomes in Unselected Patients Undergoing Coronary Angiography.

作者信息

Kuhn Lasse, Schupp Tobias, Steinke Philipp, Weidner Kathrin, Bertsch Thomas, Rusnak Jonas, Jannesari Mahboubeh, Siegel Fabian, Duerschmied Daniel, Behnes Michael, Akin Ibrahim

机构信息

Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany.

Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany.

出版信息

J Clin Med. 2025 Jan 2;14(1):224. doi: 10.3390/jcm14010224.

DOI:10.3390/jcm14010224

PMID:39797307

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11721804/

Abstract

: The study investigates sex-related differences and outcomes in unselected patients undergoing invasive coronary angiography (CA). Sex-based differences with regard to baseline characteristics and management of patients with cardiovascular disease have yet been demonstrated. However, their impact on long-term outcomes in unselected patients undergoing CA remains unknown. : Consecutive patients undergoing invasive CA from 2016 to 2022 were included at one institution. Prognosis of male and female patients undergoing CA was investigated with regard to the primary endpoint of rehospitalization for heart failure (HF) at 36 months. Secondary endpoints comprised the risk of acute myocardial infarction (AMI) and coronary revascularization at 36 months, as well as in-hospital all-cause mortality. Statistical analyses included Kaplan-Meier analyses, as well as uni- and multivariable Cox proportional regression analyses. : From 2016 to 2022, 7691 patients undergoing CA were included (males: 65.1%; females: 34.9%). Males had a higher prevalence of coronary artery disease (CAD) (76.2% vs. 57.4%; = 0.001), alongside a higher prevalence of 3-vessel CAD compared to females (33.9% vs. 20.3%; = 0.001). The risk of rehospitalization for HF at 36 months was higher in males compared to females (22.4% vs. 20.3%; = 0.036; HR = 1.127; 95% CI: 1.014-1.254; = 0.027), which was no longer observed after multivariable adjustment. Male sex was associated with a higher risk of coronary revascularization (9.6% vs. 5.9%; = 0.001; HR = 1.659; 95% CI: 1.379-1.997; = 0.001), which was still evident after multivariable adjustment (HR = 1.650; 95% CI 1.341-2.029; = 0.001). However, neither the risk of AMI at 36 months (8.1% vs. 6.9%; = 0.077), nor the risk of in-hospital all-cause mortality (6.9% vs. 6.5%; = 0.689) differed significantly between the two sexes. : In consecutive patients undergoing coronary angiography, male sex was independently associated with an increased risk of coronary revascularization, but not HF-related rehospitalization.

摘要

本研究调查了接受有创冠状动脉造影（CA）的未选择患者的性别差异及预后情况。心血管疾病患者在基线特征和治疗方面基于性别的差异尚未得到证实。然而，其对接受CA的未选择患者长期预后的影响仍不清楚。

纳入了2016年至2022年在一家机构接受有创CA的连续患者。以36个月时因心力衰竭（HF）再次住院作为主要终点，研究接受CA的男性和女性患者的预后。次要终点包括36个月时急性心肌梗死（AMI）和冠状动脉血运重建的风险，以及住院期间全因死亡率。统计分析包括Kaplan-Meier分析以及单变量和多变量Cox比例回归分析。

2016年至2022年，共纳入7691例接受CA的患者（男性：65.1%；女性：34.9%）。男性冠状动脉疾病（CAD）的患病率较高（76.2%对57.4%；P = 0.001），与女性相比，三支血管CAD的患病率也更高（33.9%对20.3%；P = 0.001）。男性36个月时因HF再次住院的风险高于女性（22.4%对20.3%；P = 0.036；HR = 1.127；95%CI：1.014 - 1.254；P = 0.027），多变量调整后未再观察到这种差异。男性性别与冠状动脉血运重建的较高风险相关（9.6%对5.9%；P = 0.001；HR = 1.659；95%CI：1.379 - 1.997；P = 0.001），多变量调整后仍然显著（HR = 1.650；95%CI 1.341 - 2.029；P = 0.001）。然而，36个月时AMI的风险（8.1%对6.9%；P = 0.077）以及住院期间全因死亡率的风险（6.9%对6.5%；P = 0.689）在两性之间无显著差异。

在接受冠状动脉造影的连续患者中，男性性别独立地与冠状动脉血运重建风险增加相关，但与HF相关的再次住院无关。