Relationship of female sex to outcomes after myocardial infarction with persistent total occlusion of the infarct artery: analysis of the Occluded Artery Trial (OAT).
Relationship of female sex to outcomes after myocardial infarction with persistent total occlusion of the infarct artery: analysis of the Occluded Artery Trial (OAT).
复制标题
女性性别与梗塞动脉持续完全闭塞的心肌梗塞后结局的关系：闭塞动脉试验（OAT）分析。
DOI：
10.1016/j.ahj.2012.01.005
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发表时间：
2012
影响因子：
4.8
通讯作者：
Hochma
中科院分区：
文献类型：
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作者：
Reynolds,HarmonyR;Forman,SandraA;Tamis-Holland,JacquelineE;Steg,PhilippeGabriel;Mark,DanielB;Pearte,CamilleA;Carvalho,AntonioC;Sopko,George;Liu,Li;Lamas,GervasioA;Kruk,Mariusz;Loboz-Grudzien,Krystyna;Ruzyllo,Witold;Hochma
OAT的长期随访（长达9年）允许在一个相对同质的心肌梗死（MI）幸存者队列中检查结果的性别差异和经皮冠状动脉介入治疗（PCI）的效果。方法OAT将484名（22%）女性和1717名男性随机分为MI后>24小时闭塞的梗死相关动脉PCI组和单纯药物治疗组。PCI对死亡、MI和IV级心力衰竭的复合终点无获益。我们分析了性别的结果，并使用同期注册研究了基于性别的试验选择偏倚。女性年龄较大，更有可能患有左前降支梗死相关动脉、糖尿病和高血压、心力衰竭病史，随机分组时有罗音，但吸烟的可能性较小。参加试验和登记的女性比例和特征相似，包括左心室射血分数和疾病程度。女性患者的主要复合终点（风险比[HR] 1.48，P = 0.0002）、死亡（HR 1.50，P = 0.001）和心力衰竭（HR 2.53，P <0.0001）的发生率较高，但未出现再梗死（HR 1.12，P = 0.57）。在多变量分析中，女性与主要终点或死亡无关。女性与心力衰竭有独立相关的趋势（HR 1.66，P = 0.02）。结论OAT中女性的主要终点事件发生率高于男性，主要由心力衰竭引起。在这个明确定义的队列中，女性与死亡或MI无关，这些队列中，冠状动脉疾病程度相似，药物治疗相似，左心室射血分数相同。
BACKGROUNDLong-term follow-up (up to 9 years) from the OAT allows for the examination of sex differences in outcomes and the effect of percutaneous coronary intervention (PCI) in a relatively homogeneous cohort of myocardial infarction (MI) survivors.METHODSThe OAT randomized 484 (22%) women and 1717 men to PCI of the occluded infarct-related artery vs medical therapy alone >24 hours post-MI. There was no benefit of PCI on the composite of death, MI, and class IV heart failure. We analyzed outcomes by sex and investigated for sex-based trial selection bias using a concurrent registry.RESULTSWomen were older and more likely to have left anterior descending infarct-related artery, diabetes and hypertension, history of heart failure, and rales at randomization but were less likely to smoke. The proportion and characteristics of women enrolled in the trial and the registry were similar, including left ventricular ejection fraction and extent of disease. Women had higher rates of the primary composite (hazard ratio [HR] 1.48, P = .0002), death (HR 1.50, P = .001), and heart failure (HR 2.53, P < .0001) but not reinfarction (HR 1.12, P = .57). Female sex was not independently associated with the primary end point or death on multivariate analysis. There was a trend toward independent association of female sex with heart failure (HR 1.66, P = .02).CONCLUSIONWomen in OAT had a higher primary end point event rate than did men, mainly driven by heart failure. Female sex was not independently associated with death or MI in this well-defined cohort with comparable extent of coronary artery disease, similar medical therapy, and equivalent left ventricular ejection fraction by sex.