不同性别≥75岁老年冠心病患者经皮冠状动脉介入治疗的预后分析
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摘要
目的:探讨不同性别≥75岁老年冠心病患者经皮冠状动脉介入治疗(PCI)后的院内及远期预后。方法:将2013年1月至12月于阜外医院行PCI且≥75岁的681例患者按性别分为男性组(n=410)和女性组(n=271),又利用倾向性评分匹配,得出基线无显著差异的男性组(n=228)和女性组(n=227)。比较2组患者匹配前后院内及2年的临床预后。采用COX回归分析性别与PCI后不良事件的相关性。结果:匹配前,女性组患者的院内全因死亡率高于男性组(2.6%vs 0.5%,P<0.05)。649例(95.3%)患者完成了2年随访。匹配后,女性组与男性组患者在院内(4.8%vs 3.1%,P=0.33)及2年随访(15.0%vs 14.9%,P=0.94)的主要心脑血管不良事件发生率差异均无统计学意义。匹配后的多因素Logistic分析(HR=3.72,95%CI:0.66~20.90,P=0.14)和COX回归分析(HR=1.43,95%CI:0.56~3.69,P=0.46)表明,性别仍不是院内及2年全因死亡的独立危险因素。结论:≥75岁老年女性患者院内全因死亡明显高于男性。不同性别≥75岁老年冠心病患者PCI后远期预后无明显差异。
Objectives: We conducted this study to investigate the in-hospital and long-term outcomes of senior male or female patients(≥75 years old) undergoing percutaneous coronary intervention(PCI).Methods: From January 2013 to December 2013, 681 consecutive patients elder than 75 years old who underwent PCI in Fuwai Hospital were included. These patients were divided into male group(n=410) and female group(n=271). Data from 228 male patients and 227 female patients were matched by propensity score-matched(PSM), In-hospital and 2-year clinical outcomes before and after PSM were compared between male and female groups. The association between sex and clinical outcomes was assessed using COX regression hazards model. Results: Before PSM, in-hospital all-cause mortality was significantly higher in female group than in male group(2.6% vs 0.5%, P<0.05). 649(95.3%) patients finished the 2-years follow-up and outcome was similar between male and female patients. After PSM, no differences were found in in-hospital or 2-year follow-up outcomes(P>0.05). Multivariate logistic regression analyses and Cox proportional hazards analysis after PSM revealed that sex was not an independent risk factor of in-hospital all-cause mortality(HR=3.72, 95%CI: 0.66~20.90, P=0.14) or 2-year follow-up(HR=1.43, 95%CI: 0.56~3.69, P=0.46).Conclusions:(1) The in-hospital all-cause mortality of female senior patients was higher than male senior patients postPCI.(2) In elderly patients over 75 years of age, sex did not influence the prognosis after percutaneous coronary intervention.
Objectives: We conducted this study to investigate the in-hospital and long-term outcomes of senior male or female patients(≥75 years old) undergoing percutaneous coronary intervention(PCI).Methods: From January 2013 to December 2013, 681 consecutive patients elder than 75 years old who underwent PCI in Fuwai Hospital were included. These patients were divided into male group(n=410) and female group(n=271). Data from 228 male patients and 227 female patients were matched by propensity score-matched(PSM), In-hospital and 2-year clinical outcomes before and after PSM were compared between male and female groups. The association between sex and clinical outcomes was assessed using COX regression hazards model. Results: Before PSM, in-hospital all-cause mortality was significantly higher in female group than in male group(2.6% vs 0.5%, P<0.05). 649(95.3%) patients finished the 2-years follow-up and outcome was similar between male and female patients. After PSM, no differences were found in in-hospital or 2-year follow-up outcomes(P>0.05). Multivariate logistic regression analyses and Cox proportional hazards analysis after PSM revealed that sex was not an independent risk factor of in-hospital all-cause mortality(HR=3.72, 95%CI: 0.66~20.90, P=0.14) or 2-year follow-up(HR=1.43, 95%CI: 0.56~3.69, P=0.46).Conclusions:(1) The in-hospital all-cause mortality of female senior patients was higher than male senior patients postPCI.(2) In elderly patients over 75 years of age, sex did not influence the prognosis after percutaneous coronary intervention.
引文
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[6]高润霖.冠心病疾病负担-中国出路[J].中国循环杂志,2017,32(1):1-4. DOI:10. 3969/j. issn. 1000-3614. 2017. 01. 001.
[7]余晓凡,李晶,王贺阳,等.不同性别老年非ST段抬高急性冠状动脉综合征患者介入治疗术后近期和远期预后分析[J].中国介人心脏病学杂志,2017, 25(1):21-26. DOI:10.3969/j.issn. 1004-8812.2017.01.006.
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[9]郭倩玉,卢成志,夏大胜,等.75岁以上急性冠状动脉综合征患者介入治疗性别对比研究[J].中华老年心脑血管病杂志,2012, 21:119-121. DOI:10.3969/j.issn.1009-0126.2012.02.003.
[10]唐晓芳,王婧,袁晋青,等.老年冠心病女性患者临床特点及经皮冠状动脉介入治疗疗效分析[J],中华临床医师杂志,2011,5(21):6239-6243. DOI:10.3877/cma.j.issn. 1674-0785.2011.21.077.
[11] Smith SC Jr, Dove JT, Jacobs AK, et al. ACC/AHA guidelines for percutaneous coronary intervention(revision of the 1993 PTCA guidelines)-executive summary:a report of the American College of Cardiology/American Heart Association task force on practice guidelines(committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty)endorsed by the society for cardiac angiography and interventions[J]. Circulation, 2001,103(24):3019-3041. DOI:10. 1016/S0735-1097(01)01344-4.
[12] Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials:a case for standardized definitions[J].Circulation, 2007, 115(17):2344-2351. DOI:10. 1161/CIRCULATIONAHA. 106. 685313.
[13] Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials:a consensus report from the bleeding academic research consortium[J]. Circulation, 2011,123(23):2736-2747. DOI:10. 1161/CIRCULATIONAHA. 110.009449.
[14] Bosch X, Casanovas N, Miranda-Guardiola F, er al. Long-term prognosis of women with non-ST-segment elevation acute coronarysyndrome. A case-control study[J]. Rev Esp Cardiol, 2002, 55(12):1235-1242.
[15] Malenka DJ, Wennberg DE, Quinton HA, et al. Gender-related changes in the practice and outcomes of percutaneous coronary interventions in Northern New England from 1994 to 1999[J]. J Am Coll Cardiol, 2002, 40(12):2092-2101. DOI:10. 1016/S0735-1097(02)02605-0.
[16]杨进刚,杨跃进.女性冠心病特点及介入治疗进展[J].心血管病学进展,2011,32(2):141-145.DOI:10. 3969/j. issn. 1004-3934. 2011.02. 001.
[17] Berger JS, Sanborn TA, Sherman W, et al. Influence of sex on inhospital outcomes and long-term survival after contemporary percutaneous coronary intervention[J]. Am Heart J, 2006, 151(5):1026-1031. DOI:10. 1016/j. ahj. 2004. 05. 062.
[18] Dodson JA, Hochman JS. Improving outcomes in older women?[J].J Am Coll Cardiol, 2015, 8(6):797-799. DOI:10. 1016/j. jcin. 2015.02. 006.
[19] Cantor WJ, Miller JM, Hellkamp AS, et al. Role of target vessel size and body surface area on outcomes after percutaneous coronary interventions in women[J]. Am Heart J, 2002, 144(2):297-302. DOI:10. 1067/mhj.2002. 123318.
[20] Liu Y, Hu X, Xue Q, et al. Influence of sex on outcomes after percutaneous coronary intervention in patients over 75 years of age with coronary heart disease[J]. Clin Interv Aging, 2014, 9:1831-1837. DOI:10. 2147/CIA. S62643.
[21] Chiu JH, Bhatt DL, Ziada KM, et al. Impact of female sex on outcome after percutaneous coronary intervention[J]. Am Heart J,2004, 148(6):998-1002. DOI:10. 1016/j. ahj. 2004. 05. 045.
[2] Cowley MJ, Mullin SM, Kelsey SF, et al. Sex differences in early and long-term results of coronary angioplasty in the NHLBI PTCA registry[J]. Circulation, 1985, 71(1):90-97. DOI:10. 1161/01. CIR.71. 1.90.
[3] Jacobs AK, Johnston JM, Haviland A, et al. Improved outcomes for women undergoing contemporary percutaneous coronary intervention:a report from the national heart, lung, and blood institute dynamic registry[J]. J Am Coll Cardiol, 2002, 39(10):1608-1614. DOI:10. 1016/S0735-1097(02)01835-1.
[4] King KM,Ghali WA,Faris PD,et al. Sex differences in outcomes after cardiac catheterization:effect modification by treatment strategy and time[J]. JAMA, 2004, 291(10):1220-1225. DOI:10. 1016/j.accreview. 2004. 04. 012.
[5]王玉珏,高展,杨进刚,等.75岁及以上老年患者经皮冠状动脉介入治疗术后远期预后的性别差异[J].中国循环杂志,2015, 30(5):438-441. DOI:10. 3969/j.issn. 1000-3614. 2015. 05. 007.
[6]高润霖.冠心病疾病负担-中国出路[J].中国循环杂志,2017,32(1):1-4. DOI:10. 3969/j. issn. 1000-3614. 2017. 01. 001.
[7]余晓凡,李晶,王贺阳,等.不同性别老年非ST段抬高急性冠状动脉综合征患者介入治疗术后近期和远期预后分析[J].中国介人心脏病学杂志,2017, 25(1):21-26. DOI:10.3969/j.issn. 1004-8812.2017.01.006.
[8]何培源,杨跃进,乔树宾,等.75岁及以上不同性别老年冠心病患者经皮冠状动脉介入治疗术后的预后分析[J].中国心血管杂志,2014, 19(4):241-245. DOI:10.3969/j.issn.1007-5410.2014.04.03.
[9]郭倩玉,卢成志,夏大胜,等.75岁以上急性冠状动脉综合征患者介入治疗性别对比研究[J].中华老年心脑血管病杂志,2012, 21:119-121. DOI:10.3969/j.issn.1009-0126.2012.02.003.
[10]唐晓芳,王婧,袁晋青,等.老年冠心病女性患者临床特点及经皮冠状动脉介入治疗疗效分析[J],中华临床医师杂志,2011,5(21):6239-6243. DOI:10.3877/cma.j.issn. 1674-0785.2011.21.077.
[11] Smith SC Jr, Dove JT, Jacobs AK, et al. ACC/AHA guidelines for percutaneous coronary intervention(revision of the 1993 PTCA guidelines)-executive summary:a report of the American College of Cardiology/American Heart Association task force on practice guidelines(committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty)endorsed by the society for cardiac angiography and interventions[J]. Circulation, 2001,103(24):3019-3041. DOI:10. 1016/S0735-1097(01)01344-4.
[12] Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials:a case for standardized definitions[J].Circulation, 2007, 115(17):2344-2351. DOI:10. 1161/CIRCULATIONAHA. 106. 685313.
[13] Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials:a consensus report from the bleeding academic research consortium[J]. Circulation, 2011,123(23):2736-2747. DOI:10. 1161/CIRCULATIONAHA. 110.009449.
[14] Bosch X, Casanovas N, Miranda-Guardiola F, er al. Long-term prognosis of women with non-ST-segment elevation acute coronarysyndrome. A case-control study[J]. Rev Esp Cardiol, 2002, 55(12):1235-1242.
[15] Malenka DJ, Wennberg DE, Quinton HA, et al. Gender-related changes in the practice and outcomes of percutaneous coronary interventions in Northern New England from 1994 to 1999[J]. J Am Coll Cardiol, 2002, 40(12):2092-2101. DOI:10. 1016/S0735-1097(02)02605-0.
[16]杨进刚,杨跃进.女性冠心病特点及介入治疗进展[J].心血管病学进展,2011,32(2):141-145.DOI:10. 3969/j. issn. 1004-3934. 2011.02. 001.
[17] Berger JS, Sanborn TA, Sherman W, et al. Influence of sex on inhospital outcomes and long-term survival after contemporary percutaneous coronary intervention[J]. Am Heart J, 2006, 151(5):1026-1031. DOI:10. 1016/j. ahj. 2004. 05. 062.
[18] Dodson JA, Hochman JS. Improving outcomes in older women?[J].J Am Coll Cardiol, 2015, 8(6):797-799. DOI:10. 1016/j. jcin. 2015.02. 006.
[19] Cantor WJ, Miller JM, Hellkamp AS, et al. Role of target vessel size and body surface area on outcomes after percutaneous coronary interventions in women[J]. Am Heart J, 2002, 144(2):297-302. DOI:10. 1067/mhj.2002. 123318.
[20] Liu Y, Hu X, Xue Q, et al. Influence of sex on outcomes after percutaneous coronary intervention in patients over 75 years of age with coronary heart disease[J]. Clin Interv Aging, 2014, 9:1831-1837. DOI:10. 2147/CIA. S62643.
[21] Chiu JH, Bhatt DL, Ziada KM, et al. Impact of female sex on outcome after percutaneous coronary intervention[J]. Am Heart J,2004, 148(6):998-1002. DOI:10. 1016/j. ahj. 2004. 05. 045.