Sex Differences in Patients Receiving Left Ventricular Assist Devices for End-Stage Heart Failure
Sex Differences in Patients Receiving Left Ventricular Assist Devices for End-Stage Heart Failure
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DOI：
10.1016/j.jchf.2020.04.015
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发表时间：
2020-09-01
影响因子：
13
通讯作者：
Desai, Nihar R.
中科院分区：
文献类型：
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作者：
Gruen, Jadry;Caraballo, Cesar;Desai, Nihar R.
本研究试图使用INTERMACS（Interagency Registry for Mechanically Assisted Circulatory Support）结果来评估左心室辅助装置（LVAD）的使用和临床结果的性别差异。背景尽管男性和女性的心力衰竭发生率相似，但先前的研究已经强调了女性LVAD的潜在使用不足，方法患者从INTERMACS研究中招募，他们在2008年至2017年期间接受了第一个连续流LVAD植入术，结果在18,868例患者中，3,984例（21.1%）为女性。1年时，女性接受心脏移植的可能性低于男性（分别为17.9% vs. 20.0%; p 0.003）。在多变量调整后，女性有更高的死亡风险（风险比[HR]：1.15; 95%置信区间[CI]：1.07 - 1.23; p < 0.001），更容易发生植入后不良事件，包括再住院、出血、中风和泵血栓形成或器械故障。尽管与同龄男性相比，50岁以下的女性死亡风险增加，（HR：1.34; 95% CI：1.12至1.6），65岁及以上的男性和女性的死亡风险相似（HR：1.09; 95%CI：0.95 ~ 1.24）结论：本研究发现女性患者LVAD术后死亡率和不良事件发生率较高。只有五分之一的LVAD被植入女性，女性接受心脏移植的可能性低于男性。需要进一步调查，以了解不良事件的原因和女性先进治疗选择的潜在使用不足。(C)2020年由美国心脏病学会基金会。
OBJECTIVES This study sought to use INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) results to evaluate sex differences in the use and clinical outcomes of left ventricular assist devices (LVAD).BACKGROUND Despite a similar incidence of heart failure in men and women, prior studies have highlighted potential underuse of LVADs in women, and studies of clinical outcomes have yielded conflicting results.METHODS Patients were enrolled from the INTERMACS study who underwent implantation of their first continuous-flow LVAD between 2008 and 2017, and survival analyses stratified by sex were conducted.RESULTS Among the 18,868 patients, 3,984 (21.1%) were women. At 1 year, women were less likely to undergo heart transplantation than men (17.9% vs. 20.0%, respectively; p 0.003). After multivariable adjustments, women had a higher risk of death (hazard ratio [HR]: 1.15; 95% confidence interval [Cl]: 1.07 to 1.23; p < 0.001) and were more likely to incur post-implantation adverse events, including rehospitalization, bleeding, stroke, and pump thrombosis or device malfunction. Although women younger than 50 years of age had an increased risk of death compared to men of the same age (HR: 1.34; 95% CI: 1.12 to 1.6), men and women 65 years of age and older had a similar risk of death (HR: 1.09; 95% CI: 0.95 to 1.24).CONCLUSIONS This study found that women had a higher risk of mortality and adverse events after LVAD. Only 1 in 5 LVADs were implanted in women, and women were less likely to receive a heart transplant than men. Further investigation is needed to understand the causes of adverse events and potential underuse of advanced treatment options in women. (C) 2020 by the American College of Cardiology Foundation.