性别对血运重建治疗策略选择及预后的影响

The Impact of Gender on Revascularization Choice and Prognosis in Coronary Artery Disease

为分析性别对血运重建治疗策略及预后的影响,采用单中心注册研究(Desire)数据,对2003年7月1日至2005年9月30日在北京安贞医院接受血运重建的患者随访。纳入患者3 809例,中位随访540天,多因素分析显示,女性是选择经皮冠状动脉介入术(PCI)治疗的独立影响因素(OR=1.235,95%CI=1.009~1.511,P=0.041)。指南推荐冠状动脉旁路移植手术(CABG)治疗的患者中,男性手术比例更高(P=0.016)。COX比例风险回归提示,血运重建方式是影响主要心脑血管疾病事件(MACCE)的独立危险因素(P<0.001)。校正患者基线特征后,接受CABG治疗患者无MACCE生存率更高。

To analyze the influence of different genders on the choice of revascularization methods and prognosis in coronary artery disease(CAD)patients.The clinical data of patients in the DESIRE(Drug-eluting Stent Impact on Revascularization)study who underwent intervention were analyzed and followed up for major adverse cardiac and cerebrovascular events(MACCE)from Jul.1st,2003 to Sep.30th,2005.The median follow-up time of 3 809 patients was 540 days.Female patients were less likely to have history of myocardial infarction,smoking,revascularization and cardiac insufficiency,while they were older and had higher prevalence of other cardiovascular risk factors than men.Though male patients had higher proportion of left main stenosis,multi-vessel disease and chronic total occlusion,female gender was an independent influential factor of choosing PCI for revascularization(OR=1.235,95%CI=1.009~1.511,P=0.041).In patients with left main stenosis and three vessel CAD with high CAD burden,female tended to have percutaneous coronary intervention(PCI)rather than CABG(P=0.016).COX regression showed that revascularization method was one independent protective factors of prognostic status(P<0.001).Among revascularization patients,female patients are more likely to be treated by PCI,which is also true for those with indication for CABG.Patients treated with PCI experienced higher incidence of MACCE during follow up.Female patients would benefit similarly as male patients from CABG therapy,while patients with indication for CABG or diabetes would benefit more.