使用微轴经皮左心室辅助装置治疗心源性休克的患者预后中与性别有关的差异

IF 2.2 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Heart, Lung and Circulation Pub Date : 2024-12-01 Epub Date: 2024-10-05 DOI:10.1016/j.hlc.2024.07.010
Johannes Mierke, Thomas Nowack, Frederike Poege, Marie Celine Schuster, Krunoslav Michael Sveric, Stefanie Jellinghaus, Felix J Woitek, Stephan Haussig, Axel Linke, Norman Mangner
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引用次数: 0

摘要

背景:尽管证据有限,但近年来在心源性休克(CS)中使用微轴向经皮左心室辅助装置(pLVAD)的情况有所增加,而有关性别差异的数据尤其稀少。本研究旨在比较男性和女性的短期疗效:德累斯顿Impella登记处是一个大型、前瞻性、单中心登记处,连续登记了接受微轴pLVAD的患者。纳入标准为左心室衰竭导致的 CS,血清乳酸大于 4 mM。不包括使用 Impella CP 以外的 pLVAD 的患者。主要终点是30天内全因死亡率或肾脏替代疗法(RRT)需求的复合终点。次要终点是主要终点的单独组成部分。采用倾向评分匹配(PSM)分析来调整基线特征:共有 319 名男性患者(69 岁;体重指数 26.7 kg/m2)和 113 名女性患者(74 岁;体重指数 27.9 kg/m2)参与了研究。在非配对分析中,女性患者的主要复合终点发生率较低(♂ 75.9% [n=239] vs ♀ 64.4% [n=72]; p=0.040),但在 PSM 分析中,女性患者的主要复合终点发生率较低(♂ 81.1% [n=73] vs ♀ 68.9% [n=42]; p=0.056)。然而,在这两项分析中,女性需要 RRT 的频率较低(♂ 48.2% [n=126] vs ♀ 25.9% [n=25]; p=0.001;PSM:♂ 49.1% [n=36] vs ♀ 23.3% [n=12]; p=0.007)。两组患者的全因死亡率没有差异:本研究显示,在CS中接受微轴pLVAD的男性和女性患者在30天内的全因死亡率没有差异。需要进行更大规模的研究,以确认女性是否与接受微轴pLVAD治疗的CS患者对RRT的需求减少有关。
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Sex-Related Differences in Outcome of Patients Treated With Microaxial Percutaneous Left Ventricular Assist Device for Cardiogenic Shock.

Background: The use of microaxial percutaneous left ventricular assist devices (pLVADs) in cardiogenic shock (CS) has increased in recent years, despite limited evidence, and data on sex disparities are particularly scarce. This study aimed to compare short-term outcomes between males and females.

Methods: Data were retrospectively collected from the Dresden Impella Registry, which is a large, prospective, single-centre registry that consecutively enrolled patients who received microaxial pLVAD. Inclusion criteria were CS due to left ventricular failure with serum lactate >4 mM. Patients with pLVAD other than Impella CP were excluded. The primary endpoint was the composite of all-cause mortality at 30 days or requirement of renal replacement therapy (RRT). Secondary endpoints were the components of the primary endpoint alone. Propensity score matched (PSM) analysis was used to adjust for baseline characteristics.

Results: A total of 319 male (69 years; body mass index, 26.7 kg/m2) and 113 female patients (74 years; 27.9 kg/m2) were included in the study. The primary composite endpoint occurred less frequently in female patients in the unmatched analysis (♂ 75.9% [n=239] vs ♀ 64.4% [n=72]; p=0.040) but not in the PSM analysis (♂ 81.1% [n=73] vs ♀ 68.9% [n=42]; p=0.056). However, females less frequently required RRT in both analyses (♂ 48.2% [n=126] vs ♀ 25.9% [n=25]; p=0.001; PSM: ♂ 49.1% [n=36] vs ♀ 23.3% [n=12]; p=0.007). All-cause mortality did not differ between the cohorts.

Conclusions: This study showed no differences in all-cause mortality at 30 days between male and female patients receiving microaxial pLVAD in CS. Larger studies are required to confirm whether female sex is associated with reduced requirement of RRT in CS treated with microaxial pLVAD.

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来源期刊
Heart, Lung and Circulation
Heart, Lung and Circulation CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
4.50
自引率
3.80%
发文量
912
审稿时长
11.9 weeks
期刊介绍: Heart, Lung and Circulation publishes articles integrating clinical and research activities in the fields of basic cardiovascular science, clinical cardiology and cardiac surgery, with a focus on emerging issues in cardiovascular disease. The journal promotes multidisciplinary dialogue between cardiologists, cardiothoracic surgeons, cardio-pulmonary physicians and cardiovascular scientists.
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