Impact of sex on outcomes associated with polyvascular disease in patients after PCI

IF 3.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American heart journal Pub Date : 2024-08-08 DOI:10.1016/j.ahj.2024.08.002
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Abstract

Background

Atherosclerosis in more than 1 vs. 1 arterial bed is associated with increased risk for major adverse cardiovascular events (MACE). This study aimed to determine whether the risk of post percutaneous coronary intervention (PCI) MACE associated with polyvascular disease (PVD) differs by sex.

Methods

We analyzed 18,721 patients undergoing PCI at a tertiary-care center between 2012 and 2019. Polyvascular disease was defined as history of peripheral artery and/or cerebrovascular disease. The primary endpoint was MACE, a composite of all-cause death, myocardial infarction, or stroke at 1 year. Multivariate Cox regression was used to adjust for differences in baseline risk between patients with PVD vs. coronary artery disease (CAD) alone and interaction testing was used to assess risk modification by sex.

Results

Women represented 29.2% (N = 5,467) of the cohort and were more likely to have PVD than men (21.7% vs. 16.1%; P < .001). Among both sexes, patients with PVD were older with higher prevalence of comorbidities and cardiovascular risk factors. Women with PVD had the highest MACE rate (10.0%), followed by men with PVD (7.2%), women with CAD alone (5.0%), and men with CAD alone (3.6%). Adjusted analyses revealed similar relative MACE risk associated with PVD vs. CAD alone in women and men (adjusted hazard ratio [aHR] 1.54, 95% confidence interval [CI] 1.20-1.99; P < .001 and aHR 1.31, 95% CI 1.06-1.62; P = .014, respectively; p-interaction = 0.460).

Conclusion

Women and men derive similar excess risk of MACE from PVD after PCI. The heightened risk associated with PVD needs to be addressed with maximized use of secondary prevention in both sexes.

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性别对 PCI 患者多血管疾病相关预后的影响。
背景:一个以上动脉床与一个以上动脉床的动脉粥样硬化与主要不良心血管事件(MACE)风险增加有关。本研究旨在确定与多血管疾病(PVD)相关的经皮冠状动脉介入治疗(PCI)后MACE风险是否因性别而异:我们分析了 2012-2019 年间在一家三级医疗中心接受 PCI 治疗的 18721 名患者。多血管疾病定义为外周动脉和/或脑血管疾病史。主要终点是MACE,即1年后全因死亡、心肌梗死或中风的复合终点。多变量 Cox 回归用于调整 PVD 患者与单纯冠状动脉疾病(CAD)患者的基线风险差异,交互检验用于评估性别对风险的影响:结果:女性占队列的 29.2%(N=5,467),比男性更有可能患有 PVD(21.7% 对 16.1%;p 结论:女性和男性的超额风险相似:女性和男性在PCI术后因PVD导致MACE的超额风险相似。需要在男女患者中最大限度地使用二级预防措施来应对与 PVD 相关的更高风险。
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来源期刊
American heart journal
American heart journal 医学-心血管系统
CiteScore
8.20
自引率
2.10%
发文量
214
审稿时长
38 days
期刊介绍: The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.
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