老年冠心病患者经皮冠状动脉介入治疗术后12个月临床疗效的性别差异

The effect of gender differences on long-term clinical outcomes among elderly patients treated with percutaneous coronary intervention

目的观察老年冠心病患者行经皮冠脉介入治疗术后12个月缺血及出血事件的发生情况,分析其性别差异。方法本研究对1 423例经皮冠状动脉介入治疗的老年患者进行I LOVE IT 2的老年亚组分析,其中老年女性患者583例,老年男性患者840例。主要终点为靶血管失败（TLF）,定义为心性死亡、心肌梗死或靶病变血运重建。结果 12个月随访时,两组患者TLF发生率分别为老年女性组6.35%,老年男性组6.19%,差异无统计学意义（P〉0.05）,但老年女性患者发生BARC出血（bleeding academic research consortium,BARC）（1-5级）的风险较老年男性患者显著增高（7.72%vs 4.52%;P=0.01）。多因素分析结果提示,老年女性是PCI术后出血并发症发生的独立危险因素（HR=1.84,95%CI：1.19-2.84,P=0.006）。结论老年女性与老年男性相比,PCI术后TLF发生率无明显差异,但出血风险显著高于老年男性。

Objective To explore the effect of gender differences on the occurrence of ischemic and bleeding events among elderly patients with coronary artery disease 1 year after undergoing percutaneous coronary intervention（PCI）. Methods As a subgroup analysis of the I-LOVE-IT2 trial, 1 423 elderly patients（women 583,men 840） with coronary artery disease treated with PCI were analyzed. Primary endpoint was target lesion failure（TLF）,defined as a composite of cardiac death,myocardial infarction and target lesion revascularization. Results The incidences of TLF were comparable for women and men at 1 year follow-up（6.35%vs 6.19%,P = 0.90）. Nevertheless,compared with men,the risk for bleeding at 1 year was significantly higher in elderly female（7.72% vs 4.52%; P = 0.01）. Cox regression analysis showed that being an elderly woman was an independent predictor of bleeding.Conclusion There are no differences by sex for TLF after PCI in elderly patients,but the risk of bleeding is significantly higher in female than in male 1 year after PCI.