Shojaei Shayan, Mousavi Asma, Soleimani Hamidreza, Takaloo Fatemeh, Roudsari Peyvand Parhizkar, Salabat Dorsa, Shahmohamady Amirreza, Mehrani Mehdi, Seilani Parisa, Ashraf Haleh, Nelson John, Thachil Rosy, Iskander Fady, Khan Safi U, Khurram Nasir, Hosseini Kaveh
Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
JACC Adv. 2025 Jan 8;4(2):101526. doi: 10.1016/j.jacadv.2024.101526. eCollection 2025 Feb.
Percutaneous coronary intervention (PCI) is considered the procedure of choice for patients with acute coronary syndrome (ACS), as it significantly improves cardiovascular outcomes. However, considerable uncertainty persists regarding the potential sex differences in PCI outcomes, due to conflicting results in previous studies.
This meta-analysis aims to evaluate potential sex-related differences in cardiovascular adverse outcomes after PCI among ACS patients.
The primary outcome was major adverse cardiovascular events (MACE) and its components. Outcomes were examined in various time frames including: short-term (within 1 month after PCI), mid-term (within 1 year), and long-term (within >1 year). A random effects model was used to estimate risk ratios (RR) and 95% CIs.
Among 32 trials, at short-term, PCI was associated with a higher risk of MACE (risk ratio [RR]: 1.43; 95% CI: 1.10-1.86), all-cause mortality (RR: 2.51; 95% CI: 1.70-3.71), and myocardial infarction (RR: 1.33; 95% CI: 1.00-1.77) in women compared with men. Over the long-term, women had a higher risk of MACE (RR: 1.11; 95% CI: 1.01-1.22), all-cause mortality (RR: 1.29; 95% CI: 1.17-1.42), and cardiovascular mortality (RR: 1.30; 95% CI: 1.11-1.52), when compared with men. However, the analysis for stroke and repeat revascularization showed no significant difference between the 2 groups in the long- and short-term.
In the meta-analysis of PCI-related trials in ACS, women have a higher risk of adverse cardiovascular outcomes compared with men.
经皮冠状动脉介入治疗（PCI）被认为是急性冠状动脉综合征（ACS）患者的首选治疗方法，因为它能显著改善心血管预后。然而，由于先前研究结果相互矛盾，PCI治疗结果中潜在的性别差异仍存在相当大的不确定性。
本荟萃分析旨在评估ACS患者PCI术后心血管不良结局中潜在的性别相关差异。
主要结局是主要不良心血管事件（MACE）及其组成部分。在不同时间框架内检查结局，包括：短期（PCI术后1个月内）、中期（1年内）和长期（超过1年）。采用随机效应模型估计风险比（RR）和95%置信区间（CI）。
在32项试验中，短期来看，与男性相比，女性接受PCI后发生MACE的风险更高（风险比[RR]：1.43；95%CI：1.10 - 1.86）、全因死亡率更高（RR：2.51；95%CI：1.70 - 3.71）以及心肌梗死风险更高（RR：1.33；95%CI：1.00 - 1.77）。长期来看，与男性相比，女性发生MACE的风险更高（RR：1.11；95%CI：1.01 - 1.22）、全因死亡率更高（RR：1.29；95%CI：1.17 - 1.42）以及心血管死亡率更高（RR：1.30；95%CI：1.11 - 1.52）。然而，对中风和再次血管重建的分析显示，两组在长期和短期均无显著差异。
在对ACS中PCI相关试验的荟萃分析中，女性与男性相比，发生心血管不良结局的风险更高。
