非ST段抬高型急性冠状动脉综合征早期侵入性策略疗效的年龄和性别差异：稳定患者的比较分析
Age and sex differences in the efficacy of early invasive strategy for non-ST-elevation acute coronary syndrome: A comparative analysis in stable patients.
作者信息
Cenko Edina, Bergami Maria, Yoon Jinsung, Vadalà Giuseppe, Kedev Sasko, Kostov Jorgo, Vavlukis Marija, Vraynko Elif, Miličić Davor, Vasiljevic Zorana, Zdravkovic Marija, Galassi Alfredo R, Manfrini Olivia, Bugiardini Raffaele
机构信息
Laboratory of Epidemiological and Clinical Cardiology. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Google Cloud AI, Sunnyvale, CA, USA.
出版信息
Am J Prev Cardiol. 2025 Mar 29;22:100984. doi: 10.1016/j.ajpc.2025.100984. eCollection 2025 Jun.
OBJECTIVE
Previous works have struggled to clearly define sex-specific outcomes based on initial management in NSTE-ACS patients. We examined if early revascularization (<24 h) versus conservative strategy impacts differently based on sex and age in stable NSTE-ACS patients upon hospital admission.
METHODS
We identified 8905 patients with diagnosis of non-ST elevation acute coronary syndromes (NSTE-ACS) in the ISACS-TC database. Patients with cardiac arrest, hemodynamic instability, and serious ventricular arrhythmias were excluded. The final cohort consisted of 7589 patients. The characteristics between groups were adjusted using inverse probability of treatment weighting models. Primary outcome measure was all-cause 30-day mortality. Risk ratios (RRs) with their 95 % CIs were employed.
RESULTS
Of the 7589 NSTE-ACS patients identified, 2450 (32.3 %) were women. The data show a notable reduction in mortality for the older women (aged 65 years and older) undergoing early invasive strategy compared to those receiving an initial conservative (3.0 % versus 5.1 %; RR: 0.57; 95 % CI: 0.32 - 0.99) Conversely, younger women did not exhibit a significant association between early invasive strategy and mortality reduction (2.0 % versus 0.9 %; RR: 2.27; 95 % CI: 0.73 - 7.04). For men, age stratification did not markedly alter the observed benefits of an early invasive strategy over a conservative approach in the overall population, with reduced death rates in both older (3.1 % versus 5.7 %; RR: 0.52; 95 % CI: 0.34 - 0.80) and younger age groups (0.8 % versus 1.7 %; RR: 0.46; 95 % CI: 0.22 - 0.94). These age and sex-specific mortality patterns did not significantly change within subgroups stratified by the presence of NSTEMI, or a GRACE risk score>140.
CONCLUSION
Early coronary revascularization is associated with improved 30-day survival in older men and women and younger men who present to hospital in stable conditions after NSTE-ACS. It does not confer a survival advantage in young women. Further studies are needed to more accurately risk-stratify young women to guide treatment strategies.
REGISTRATION
ClinicalTrials.gov: NCT01218776.
目的
以往的研究难以根据非ST段抬高型急性冠脉综合征（NSTE-ACS）患者的初始治疗明确界定性别特异性结局。我们研究了在稳定的NSTE-ACS患者入院时，早期血运重建（<24小时）与保守策略对不同性别和年龄患者的影响是否存在差异。
方法
我们在ISACS-TC数据库中识别出8905例诊断为非ST段抬高急性冠脉综合征（NSTE-ACS）的患者。排除心脏骤停、血流动力学不稳定和严重室性心律失常的患者。最终队列包括7589例患者。使用治疗权重逆概率模型对组间特征进行调整。主要结局指标是全因30天死亡率。采用风险比（RRs）及其95%置信区间。
结果
在识别出的7589例NSTE-ACS患者中，2450例（32.3%）为女性。数据显示，与接受初始保守治疗的老年女性（年龄≥65岁）相比，接受早期侵入性策略的老年女性死亡率显著降低（3.0%对5.1%；RR：0.57；95%置信区间：0.32 - 0.99）。相反，年轻女性中早期侵入性策略与死亡率降低之间未显示出显著关联（2.0%对0.9%；RR：2.27；95%置信区间：0.73 - 7.04）。对于男性，年龄分层并未显著改变在总体人群中早期侵入性策略相对于保守方法所观察到的益处，老年组（3.1%对5.7%；RR：0.52；95%置信区间：0.34 - 0.80）和年轻组（0.8%对1.7%；RR：0.46；95%置信区间：0.22 - 0.94）的死亡率均降低。在按非ST段抬高心肌梗死（NSTEMI）的存在或GRACE风险评分>140分层的亚组中，这些年龄和性别特异性的死亡率模式没有显著变化。
结论
早期冠脉血运重建与NSTE-ACS后以稳定状态入院的老年男性和女性以及年轻男性30天生存率的提高相关。它并未赋予年轻女性生存优势。需要进一步研究以更准确地对年轻女性进行风险分层，从而指导治疗策略。
注册信息
ClinicalTrials.gov：NCT01218776。
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