Long-Term Outcomes of Sex Differences in Three-Vessel Coronary Disease with Different Treatment Strategies: A Large Cohort Study.

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Global Heart Pub Date : 2024-07-03 eCollection Date: 2024-01-01 DOI:10.5334/gh.1333

Jiawen Li, Lin Jiang, Lianjun Xu, Jian Tian, Xinxing Feng, Dong Wang, Yin Zhang, Rutai Hui, Runlin Gao, Lei Song, Jinqing Yuan, Xueyan Zhao

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Abstract

Aim: The information assessing sex differences in outcomes of patients with three-vessel coronary disease (TVD) after different treatment strategies is sparse. This study aimed to investigate long-term outcomes of TVD among women compared with men after medical therapy (MT) alone, percutaneous coronary intervention (PCI), or coronary artery bypass grafting surgery (CABG).

Methods: Consecutive 8943 patients with TVD were enrolled. Associations between sex and all-cause death and major adverse cardiac and cerebrovascular events (MACCE) (all-cause death, myocardial infarction, or stroke) were assessed.

Results: Of the 8943 patients, 1821 (20.4%) were women. During a median follow-up of 6.6 years, women had comparable incidences of all-cause death (16.6% vs. 14.9%, P = 0.079) and MACCE (27.2% vs. 26.1%, P = 0.320) to men. After multivariable analysis, women showed lower adjusted risks of all-cause death (HR: 0.777; P = 0.001) and MACCE (HR: 0.870; P = 0.016) than men in the entire cohort. Subgroup analysis revealed that the less all-cause death risk of women relative to men was significant in PCI (HR: 0.702; P = 0.009), and CABG groups (HR: 0.708; P = 0.047), but not in MT alone group. Lower MACCE risk for women vs. men was significant only in PCI group (HR: 0.821; P = 0.037). However, no significant interaction between sex and three strategies was observed for all-cause death (P for interaction = 0.312) or MACCE (P for interaction = 0.228).

Conclusions: The cardiovascular prognosis of TVD female patients is better than that of men, which has no interaction with the treatment strategies received (MT alone, PCI, or CABG).

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不同治疗策略下三血管冠心病性别差异的长期预后：大型队列研究

目的：评估三血管冠状动脉疾病（TVD）患者在接受不同治疗策略后的预后性别差异的资料很少。本研究旨在调查女性与男性相比，在接受单纯药物治疗（MT）、经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植手术（CABG）后，TVD 患者的长期预后情况：方法：连续招募了 8943 名 TVD 患者。评估了性别与全因死亡和主要不良心脑血管事件（MACCE）（全因死亡、心肌梗死或中风）之间的关系：在 8943 名患者中，有 1821 名女性（占 20.4%）。在中位随访 6.6 年期间，女性全因死亡（16.6% 对 14.9%，P = 0.079）和 MACCE（27.2% 对 26.1%，P = 0.320）的发生率与男性相当。经过多变量分析，在整个队列中，女性全因死亡（HR：0.777；P = 0.001）和MACCE（HR：0.870；P = 0.016）的调整风险低于男性。亚组分析显示，在 PCI 组（HR：0.702；P = 0.009）和 CABG 组（HR：0.708；P = 0.047），女性的全因死亡风险显著低于男性，但在单纯 MT 组中，女性的全因死亡风险显著低于男性。女性 MACCE 风险低于男性仅在 PCI 组显著（HR：0.821；P = 0.037）。然而，在全因死亡（交互作用 P = 0.312）或 MACCE（交互作用 P = 0.228）方面，没有观察到性别与三种策略之间的明显交互作用：结论：TVD女性患者的心血管预后优于男性，这与所接受的治疗策略（单纯MT、PCI或CABG）无交互作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Global Heart Medicine-Cardiology and Cardiovascular Medicine

CiteScore

5.70

自引率

5.40%

发文量

审稿时长

5 weeks

期刊介绍： Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources. Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention. Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.