Sex Differences in Patients Undergoing Left Main Stem Percutaneous Coronary Intervention for Stable Angina: Data From a National Registry.

IF 5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of the American Heart Association Pub Date : 2024-11-19 Epub Date: 2024-11-15 DOI:10.1161/JAHA.124.036569
Warkaa Shamkhani, Zafraan Zathar, Sophia Khattak, James Nolan, Alaide Chieffo, Tim Kinnaird, Mamas A Mamas
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Abstract

Background: Percutaneous coronary intervention (PCI) of the left main coronary artery (LMCA) for stable angina has steadily increased. Outcomes stratified by sex are inconclusive and limited. We assessed sex-based trends and differences in clinical outcomes among patients with stable angina who received LMCA PCI.

Methods and results: We retrospectively collected data on patients with stable angina who underwent LMCA PCI (2006-2022) from the UK national PCI registry. The primary outcome of interest was inpatient mortality. Secondary outcomes were major bleeding and major cardiovascular and cerebral events. Multivariate logistic regression was used to assess adjusted odds ratio for outcome of interest. Of the 24 271 LMCA PCI performed, 5497 (22.7%) were in women. Women were older than men (median 72.7 versus 70.4) and less likely to have their PCI via radial access (50.3% versus 58.9%). More women had PCI guided by intravascular ultrasound (43.4% versus 41.2%). Women had significantly lower comorbid burden than men. Higher prevalence of chronic renal failure (6.72% versus 4.77%), smoking history (61.47% versus 45.68%), diabetes (27.36% versus 25.74%), prior myocardial infarction (45.36% versus 35.89%), and prior coronary artery bypass grafting (42.13% versus 30.34%) was observed in men than in women, respectively; P value <0.005 for all. Women had higher adjusted mortality (adjusted odds ratio, 1.63 [95% CI, 1.1-2.3]) and major bleeding events (adjusted odds ratio, 2.07 [95% CI, 1.19-3.59]). Although odds of major cardiovascular and cerebral events (adjusted odds ratio, 1.27[95% CI, 0.9-1.6]) were higher in women, it was not statistically significant.

Conclusions: Despite being less comorbid, women had a significant increase in their mortality and major bleeding events following LMCA PCI. A sex-tailored approach considering age, intravascular imaging, and vascular access may improve outcomes.

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左主干经皮冠状动脉介入治疗稳定型心绞痛患者的性别差异:来自国家登记处的数据
背景:用于治疗稳定型心绞痛的左冠状动脉主干(LMCA)经皮冠状动脉介入治疗(PCI)逐渐增多。按性别分层的疗效尚无定论且有限。我们评估了接受 LMCA PCI 的稳定型心绞痛患者的性别趋势和临床结果差异:我们从英国国家 PCI 登记处回顾性收集了接受 LMCA PCI 的稳定型心绞痛患者的数据(2006-2022 年)。主要研究结果为住院患者死亡率。次要结果是大出血和重大心脑血管事件。多变量逻辑回归用于评估相关结果的调整赔率。在实施的 24 271 例 LMCA PCI 中,有 5497 例(22.7%)为女性。女性的年龄比男性大(中位数为 72.7 岁对 70.4 岁),通过桡动脉入路进行 PCI 的可能性较小(50.3% 对 58.9%)。更多女性在血管内超声引导下进行 PCI(43.4% 对 41.2%)。女性的合并症负担明显低于男性。男性慢性肾功能衰竭(6.72% 对 4.77%)、吸烟史(61.47% 对 45.68%)、糖尿病(27.36% 对 25.74%)、既往心肌梗死(45.36% 对 35.89%)和既往冠状动脉旁路移植术(42.13% 对 30.34%)的发病率分别高于女性;P 值 结论:尽管女性的合并症较少,但她们在 LMCA PCI 术后的死亡率和大出血事件显著增加。考虑年龄、血管内成像和血管通路的性别定制方法可能会改善预后。
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来源期刊
Journal of the American Heart Association
Journal of the American Heart Association CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
9.40
自引率
1.90%
发文量
1749
审稿时长
12 weeks
期刊介绍: As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice. JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.
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