Association of Sex with Outcome in Elderly Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

被引：10

作者：

De Rosa, Roberta ^{[1
,2
]}

Morici, Nuccia ^{[3
,4
]}

De Luca, Giuseppe ^{[5
]}

De Luca, Leonardo ^{[6
]}

Ferri, Luca A. ^{[7
]}

Piatti, Luigi ^{[8
]}

Tortorella, Giovanni ^{[9
]}

Grosseto, Daniele ^{[10
]}

Franco, Nicoletta ^{[10
]}

Misuraca, Leonardo ^{[11
]}

Sganzerla, Paolo ^{[12
]}

Cacucci, Michele ^{[13
]}

Antonicelli, Roberto ^{[14
]}

Cavallini, Claudio ^{[15
]}

Lenatti, Laura ^{[8
]}

Leuzzi, Chiara ^{[16
]}

Murena, Ernesto ^{[17
]}

Ravera, Amelia ^{[1
]}

Ferrario, Maurizio ^{[18
]}

Corrada, Elena ^{[19
]}

Colombo, Delia ^{[20
]}

Prati, Francesco ^{[21
]}

Piscione, Federico ^{[1
]}

Petronio, A. Sonia ^{[22
]}

Galasso, Gennaro ^{[1
]}

De Servi, Stefano ^{[23
]}

Savonitto, Stefano ^{[8
]}

机构：

[1] Univ Hosp San Giovanni Dio & Ruggi dAragona, Salerno, Italy

[2] Goethe Univ Hosp Frankfurt, Frankfurt, Germany

[3] ASST Grande Osped Metropolitano Niguarda, Milan, Italy

[4] Univ Milo, Dept Clin Sci & Community Hlth, Milan, Italy

[5] Eastern Piedmont Univ, Azienda Osped Univ Maggiore Carita, Novara, Italy

[6] Azienda Osped San Camillo Forlanini, Rome, Italy

[7] Ist Sci San Raffaele, Milan, Italy

[8] Manzoni Hosp, Lecce, Italy

[9] Osped Vaio, Fidenza, Italy

[10] Osped Infermi, Rimini, Italy

[11] Osped Misericordia, Grosseto, Italy

[12] ASST Bergamo Ovest Osped Treviglio, Treviglio, Italy

[13] Osped Maggiore Crema, Crema, Italy

[14] IRCCS Ist Nazl Ric & Cura Anziano, Ancona, Italy

[15] Osped S Maria Misericordia, Perugia, Italy

[16] IRCCS Arcispedale S Maria Nuova, Reggio Emilia, Italy

[17] Osped S Maria delle Grazie, Pozzuoli, Italy

[18] IRCCS Fdn Policlin S Matteo, Pavia, Italy

[19] IRCCS, Humanitas Clin & Res Ctr, Rozzano, Italy

[20] Clin Pharmacol, Milan, Italy

[21] Osped S Giovanni Addolorata, Rome, Italy

[22] Azienda Osped Univ Pisana, Pisa, Italy

[23] Univ Pavia, Pavia, Italy

来源：

AMERICAN JOURNAL OF MEDICINE | 2021年 / 134卷 / 09期

关键词：

Acute coronary syndrome; Elderly; Percutaneous coronary intervention; ELEVATION-MYOCARDIAL-INFARCTION; CARDIOVASCULAR-DISEASE; POSTMENOPAUSAL WOMEN; PRIMARY ANGIOPLASTY; ARTERY-DISEASE; AGE; GENDER; SURVIVAL; INSIGHTS; EXTENT;

D O I：

10.1016/j.amjmed.2021.03.025

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Worse outcomes have been reported for women, compared with men, after an acute coronary syndrome (ACS). Whether this difference persists in elderly patients undergoing similar invasive treatment has not been studied. We investigated sex-related differences in 1-year outcome of elderly acute coronary syndrome patients treated by percutaneous coronary intervention (PCI). METHODS: Patients 75 years and older successfully treated with PCI were selected among those enrolled in 3 Italian multicenter studies. Cox regression analysis was used to assess the independent predictive value of sex on outcome at 12-month follow-up. RESULTS: A total of 2035 patients (44% women) were included. Women were older and most likely to present with ST-elevation myocardial infarction (STEMI), diabetes, hypertension, and renal dysfunction; men were more frequently overweight, with multivessel coronary disease, prior myocardial infarction, and revascularizations. Overall, no sex disparity was found about all-cause (8.3% vs 7%, P = .305) and cardiovascular mortality (5.7% vs 4.1%, P = .113). Higher cardiovascular mortality was observed in women after STEMI (8.8%) vs 5%, P = .041), but not after non ST-elevation-ACS (3.5% vs 3.7%, P = .999). A sensitivity analysis excluding patients with prior coronary events (N = 1324, 48% women) showed a significantly higher cardiovascular death in women (5.4% vs 2.9%, P = .025). After adjustment for baseline clinical variables, female sex did not predict adverse outcome. CONCLUSIONS: Elderly men and women with ACS show different clinical presentation and baseline risk profile. After successful PCI, unadjusted 1-year cardiovascular mortality was significantly higher in women with STEMI and in those with a first coronary event. However, female sex did not predict cardiovascular mortality after adjustment for the different baseline variables. (C) 2021 Elsevier Inc. All rights reserved.

引用

页码：1135 / +

页数：8

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