Peri-procedural complications in women: an alarming and consistent trend.
Peri-procedural complications in women: an alarming and consistent trend.
复制标题
女性围手术期并发症：一个令人震惊且一致的趋势。
DOI：
10.1093/eurheartj/ehz193
复制
发表时间：
2019
影响因子：
39.3
通讯作者：
Shah,RashmeeU
中科院分区：
文献类型：
--
作者：
Wang,Libo;Selzman,KimberlyA;Shah,RashmeeU
房颤（AF）是全球最常见的持续性心律失常，男性和女性的终生风险相似。1由于女性的预期寿命较长，她们占房颤患者的一半以上，特别是在老年人群中。2研究表明，女性房颤患者往往症状更明显，对药物治疗的反应更低，生活质量更低。3因此，医疗界不仅要研究房颤治疗（如导管消融），而且要评估这些治疗对男性和女性是否同样安全有效。在本期《欧洲心脏杂志》中，Cheung等人研究了真实世界队列中房颤消融术后基于性别的结局，包括美国国家再入院数据库中的> 50000例患者。4女性占接受AF消融术患者的三分之一，与男性相比，女性年龄更大，总体合并症负担更高。女性的住院并发症发生率较高（8.3% vs. 5.6%），原因是出血、血管并发症和心脏穿孔增加。在30天的随访中，女性的再入院率高出4%（13.4% vs. 9.4%），这是由房颤复发和心力衰竭引起的。这项研究是最新的，也是最大的多项研究，旨在研究房颤消融术结局的性别差异。一个一致的信息出现：并发症发生率较高的女性接受房颤消融术相比，男性。Kaiser等人，使用健康保险索赔数据库，发现由穿孔、出血和血管并发症引起的围手术期并发症的发生率增加，1年时重复住院的绝对增加5%。5 Zylla等人评价了德国房颤消融登记研究，发现女性患者并发症增加相似，尤其是血管通路并发症。6
Atrial fibrillation (AF) is the most common, sustained arrhythmia worldwide, with similar lifetime risks for men and women. 1 Since women have longer life expectancies, they account for over half of AF patients, particularly in older populations. 2 Research suggests that women with AF tend to be more symptomatic, less responsive to pharmacotherapy, and report a lower quality of life. 3 It is therefore essential for the healthcare community not only to study AF therapies such as catheter ablation, but also to assess whether these treatments are equally safe and effective for both men and women. In this issue of the European Heart Journal, Cheung et al. examine sex-based outcomes after AF ablation in a real-world cohort, including> 50 000 patients in the US National Readmissions Database. 4 Women accounted for a third of patients who underwent AF ablation, and were older with a higher overall comorbidity burden compared with men. The in-hospital complication rate was higher among women (8.3% vs. 5.6%), driven by increased bleeding, vascular complications, and cardiac perforations. In 30-day follow-up, the readmission rate was 4% higher among women (13.4% vs. 9.4%), driven by AF recurrence and heart failure.This study is the most recent and largest of multiple studies looking at sex-based differences in outcomes of AF ablation. A consistent message emerges: complication rates are higher in women who undergo AF ablation compared with men. Kaiser et al., using a health insurance claims database, found increased rates of peri-procedural complications driven by perforation, bleed, and vascular complications, with a 5% absolute increase in repeat hospitalizations at 1 year. 5 Zylla et al. evaluated the German AF ablation registry, with similarly increased complications in women, particularly vascular access complications. 6