Background: Females with ST-segment elevation myocardial infarction (STEMI) have higher in-hospital and short-term mortality rates compared with males in China, suggesting that a sex disparity exists. The age of on...Background: Females with ST-segment elevation myocardial infarction (STEMI) have higher in-hospital and short-term mortality rates compared with males in China, suggesting that a sex disparity exists. The age of onset of STEM1 is ahead of time and tends to be younger. However, there are relatively little data on the significance of sex on prognosis for long-term outcomes for adult patients with STEMI alter percutaneous coronary intervention (PCI) in China. This study sought to analyze the sex differences in 30-day, l-year, and long-term net adverse clinical events (NACEs) in Chinese adult patients with STEMI after PCI. Methods: This study retrospectively analyzed 1920 consecutive STEMI patients (age 〈60 years) treated with PCI fYom January 01, 2006, to December 31,2012. A propensity score analysis between males and females was perfimned to adjust tbr differences in baseline characteristics and comorbidities. The primary endpoint was the incidence of 3-year NACE. Survival curves were constructed with Kaplan- Meier estimates and compared by log-rank tests between the two groups. Multivariate analysis was perforated using a Cox proportional hazards model for 3-year NACE. Results: Compared with males, females had higher risk profiles associated with old age, longer prehospital delay at the onset of STEMI, hypertension, diabetes mellitus, and chronic kidney disease, and a higher Killip class (≥3), with more multivessel diseases (P 〈 0.05). The female group had a higher levels of low-density lipoprotein (2.72 [2.27, 3.29] vs. 2.53 [2,12, 3.00], P 〈 (1.001), high-density lipoprotein ( 1.43 [1.23, 1.71] vs. 1.36 [1.11, 1.63], P - 0.003), total cholesterol (4.98±1.10 vs. 4.70 ±1.15, t = -3.508, P 〈 0.001), and estimated glomerular filtration rate (103.12 ± 22.22 vs. 87.55 ±18.03, t = 11.834, P〈 0.001 ) than the male group. In the propensity-matched analysis, being female was associated with a higher risk for 3-year NACE and major adverse cardiac or cerebral events compared with males. In the multivariate model, female gender (hazard ratio [HR]: 2.557, 95% confidence interval [CI]: 1.415-4.620, P=0.002), hypertension (MR: 2.017, 95% CI: 1.138-3.576, P = 0.016), and family history of coronary heart disease (HR: 2.256, 95% CI:1.115-4.566, P = 0.024) were independent risk factors for NACE. The number of stents (HR: 0.625, 95% CI:0.437 0.894, P = 0.010) was independent protective factors of NACE. Conclusions: Females with STEMI undergoing PCl have a significantly higher risk for 3-year NACE compared with males in this population. Sex differences appear to be a risk factor and present diagnostic challenges for clinicians.展开更多
Background:There is scanty evidence concerning the ability of Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) and Ac...Background:There is scanty evidence concerning the ability of Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) and Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (ACUITY-HORIZONS) scores to predict out-of-hospital bleeding risk after percutaneous coronary interventions (PCIs) with drug-eluting stents (DES) in patients receiving dual antiplatelet therapy.We aimed to assess and compare the long-term prognostic value of these scores regarding out-of-hospital bleeding risk in such patients.Methods:We performed a prospective observational study of 10,724 patients undergoing PCI between January and December 2013 in Fuwai Hospital,China.All patients were followed up for 2 years and evaluated through the Fuwai Hospital Follow-up Center.Major bleeding was defined as Types 2,3,and 5 according to Bleeding Academic Research Consortium Definition criteria.Results:During a 2-year follow-up,245 of 9782 patients (2.5%) had major bleeding (MB).CRUSADE (21.00 [12.00,29.75] vs.18.00 [11.00,26.00],P 〈 0.001) and ACUITY-HORIZONS (9.00 [3.00,14.00] vs.6.00 [3.00,12.00],P 〈 0.001) risk scores were both significantly higher in the MB than non-MB groups.Both scores showed a moderate predictive value for MB in the whole study cohort (area under the receiver-operating characteristics curve [AUROC],0.565;95% confidence interval [CI],0.529-0.601,P =0.001;AUROC,0.566;95% CI,0.529-0.603,P 〈 0.001,respectively) and in the acute coronary syndrome (ACS) subgroup (AUROC:0.579,95% CI:0.531-).627,P =0.001;AUROC,0.591;95% CI,0.544-0.638,P 〈 0.001,respectively).However,neither score was a significant predictor in the non-ACS subgroup (P 〉 0.05).The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly (P 〉 0.05) in the whole cohort,ACS subgroup,or non-ACS subgroup.Conclusions:CRUSADE and ACUITY-HORIZONS scores showed statistically significant but relatively limited long-term prognostic value for out-of-hospital MB after PCI with DES in a cohort of Chinese patients.The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly (P 〉 0.05) in the whole cohort,ACS subgroup,or non-ACS subgroup.展开更多
文摘Background: Females with ST-segment elevation myocardial infarction (STEMI) have higher in-hospital and short-term mortality rates compared with males in China, suggesting that a sex disparity exists. The age of onset of STEM1 is ahead of time and tends to be younger. However, there are relatively little data on the significance of sex on prognosis for long-term outcomes for adult patients with STEMI alter percutaneous coronary intervention (PCI) in China. This study sought to analyze the sex differences in 30-day, l-year, and long-term net adverse clinical events (NACEs) in Chinese adult patients with STEMI after PCI. Methods: This study retrospectively analyzed 1920 consecutive STEMI patients (age 〈60 years) treated with PCI fYom January 01, 2006, to December 31,2012. A propensity score analysis between males and females was perfimned to adjust tbr differences in baseline characteristics and comorbidities. The primary endpoint was the incidence of 3-year NACE. Survival curves were constructed with Kaplan- Meier estimates and compared by log-rank tests between the two groups. Multivariate analysis was perforated using a Cox proportional hazards model for 3-year NACE. Results: Compared with males, females had higher risk profiles associated with old age, longer prehospital delay at the onset of STEMI, hypertension, diabetes mellitus, and chronic kidney disease, and a higher Killip class (≥3), with more multivessel diseases (P 〈 0.05). The female group had a higher levels of low-density lipoprotein (2.72 [2.27, 3.29] vs. 2.53 [2,12, 3.00], P 〈 (1.001), high-density lipoprotein ( 1.43 [1.23, 1.71] vs. 1.36 [1.11, 1.63], P - 0.003), total cholesterol (4.98±1.10 vs. 4.70 ±1.15, t = -3.508, P 〈 0.001), and estimated glomerular filtration rate (103.12 ± 22.22 vs. 87.55 ±18.03, t = 11.834, P〈 0.001 ) than the male group. In the propensity-matched analysis, being female was associated with a higher risk for 3-year NACE and major adverse cardiac or cerebral events compared with males. In the multivariate model, female gender (hazard ratio [HR]: 2.557, 95% confidence interval [CI]: 1.415-4.620, P=0.002), hypertension (MR: 2.017, 95% CI: 1.138-3.576, P = 0.016), and family history of coronary heart disease (HR: 2.256, 95% CI:1.115-4.566, P = 0.024) were independent risk factors for NACE. The number of stents (HR: 0.625, 95% CI:0.437 0.894, P = 0.010) was independent protective factors of NACE. Conclusions: Females with STEMI undergoing PCl have a significantly higher risk for 3-year NACE compared with males in this population. Sex differences appear to be a risk factor and present diagnostic challenges for clinicians.
文摘Background:There is scanty evidence concerning the ability of Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) and Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (ACUITY-HORIZONS) scores to predict out-of-hospital bleeding risk after percutaneous coronary interventions (PCIs) with drug-eluting stents (DES) in patients receiving dual antiplatelet therapy.We aimed to assess and compare the long-term prognostic value of these scores regarding out-of-hospital bleeding risk in such patients.Methods:We performed a prospective observational study of 10,724 patients undergoing PCI between January and December 2013 in Fuwai Hospital,China.All patients were followed up for 2 years and evaluated through the Fuwai Hospital Follow-up Center.Major bleeding was defined as Types 2,3,and 5 according to Bleeding Academic Research Consortium Definition criteria.Results:During a 2-year follow-up,245 of 9782 patients (2.5%) had major bleeding (MB).CRUSADE (21.00 [12.00,29.75] vs.18.00 [11.00,26.00],P 〈 0.001) and ACUITY-HORIZONS (9.00 [3.00,14.00] vs.6.00 [3.00,12.00],P 〈 0.001) risk scores were both significantly higher in the MB than non-MB groups.Both scores showed a moderate predictive value for MB in the whole study cohort (area under the receiver-operating characteristics curve [AUROC],0.565;95% confidence interval [CI],0.529-0.601,P =0.001;AUROC,0.566;95% CI,0.529-0.603,P 〈 0.001,respectively) and in the acute coronary syndrome (ACS) subgroup (AUROC:0.579,95% CI:0.531-).627,P =0.001;AUROC,0.591;95% CI,0.544-0.638,P 〈 0.001,respectively).However,neither score was a significant predictor in the non-ACS subgroup (P 〉 0.05).The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly (P 〉 0.05) in the whole cohort,ACS subgroup,or non-ACS subgroup.Conclusions:CRUSADE and ACUITY-HORIZONS scores showed statistically significant but relatively limited long-term prognostic value for out-of-hospital MB after PCI with DES in a cohort of Chinese patients.The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly (P 〉 0.05) in the whole cohort,ACS subgroup,or non-ACS subgroup.