冠状动脉内支架术预后的性别差异

Sex differences in outcomes of elective coronary stenting in patients with coronary artery disease

目的 :探讨性别因素对冠心病患者选择性冠状动脉 (冠脉 )内支架术近期结果和远期预后的影响。方法 :连续682例冠心病患者行选择性冠脉内支架术 ,其中男性 543例 ,女性 13 9例。比较二者支架术近期结果及远期随访。结果 :男、女两组支架术成功率 (95.8%和 97.1% ,P=0 .464)相似 ,但女性手术并发症较男性显著增多 (5.0 %和0 .9% ,P=0 .0 0 3 )。多因素分析显示性别是手术并发症的独立预测因素 (RR 4.86,95% CI 1.2 9～ 18.4,P=0 .0 2 0 )。随访 16± 8月 ,随访率为 94.8%。随访期内 ,男、女两组心脏事件发生率 (2 1.4%和 2 2 .3 % )、病死率 (4.6%和 4.6% )及造影再狭窄率 (13 .1%和 14 .6% )差异均无显著性 (均 P>0 .0 5) ,多因素分析显示 ,性别不是冠脉内支架术后远期心脏事件和死亡的独立预测因素。结论 :性别对选择性冠脉内支架术远期预后无明显影响 。

AIM: To investigate the effect of sex on initial and l ong-term outcome s following coronary stenting in patients with coronary artery disease. ME THODS: This prospective study comprised 682, consecutive patients with coronary arter y disease who underwent selective coronary stenting, including 139 women (female g roup) and 543 men(male group), the initial results and long-term follow-up ou tco mes were compared. RESULTS: There was no significant difference in the procedural success rate between the two groups(97.1% vs 95.8%) (P=0.464), but the procedural complication rate was higher in the female gr oup than in the male group(5.0% vs 0.9%, P=0.003). Multivariate analysis showed that sex was an independent predictor of procedural complications (relative risk 4.86, 95% CI 1 . 29~18.4, P=0.020). The follow-up rate was 94 8%(mean duration, 16±8 month s). There were no significant differences in the occurrence rates of composite events (22. 3% v s 21.4%), mortality (4.6% vs 4.6%) and angiographic restenosis(14.6% vs 13. 1%) between the two groups(all P>0.05). Logistic regression analysis also in dica ted that sex was not an independent predicator for long-term composite events a n d mortality. CONCLUSION: Sex may have no influence on long-term outco mes of e lective coronary stenting, but it may be an independent predictor of procedura l complications.