Treatment Effect of Percutaneous Coronary Intervention in Men Versus Women With ST-Segment-Elevation Myocardial Infarction.
Treatment Effect of Percutaneous Coronary Intervention in Men Versus Women With ST-Segment-Elevation Myocardial Infarction.
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DOI：
10.1161/jaha.121.021638
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发表时间：
2021-09-21
影响因子：
5.4
通讯作者：
Alkhouli M
中科院分区：
文献类型：
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作者：
Sulaiman S;Kawsara A;Mohamed MO;Van Spall HGC;Sutton N;Holmes DR;Mamas MA;Alkhouli M
女性接受直接经皮冠状动脉介入治疗(PPCI)的可能性低于男性。一个潜在的原因是风险厌恶，因为pPCI在女性中的结果更差。然而，在男性和女性中，pPCI是否与类似的死亡率收益相关仍不清楚。我们选择了2016-2018年国家住院患者样本中主要诊断为ST段抬高心肌梗死的患者。我们使用倾向-评分匹配来计算pPCI对住院死亡率、主要并发症、住院时间和费用的平均治疗效果。作为敏感性分析，我们使用Logit模型和一个边际命令来计算平均边际效应。我们纳入了413-500例加权住院(30.7%女性，69.3%男性)。除吸烟和既往胸骨切开外，女性有更多的合并症。与男性相比，女性较少接受血管造影术(81.0%比87.0%；调整优势比0.77；95%可信区间0.74-0.81；P<；0.001)或介入治疗(74.0%比82.0%；调整后优势比0.76；95%可信区间0.73-0.79；P<；0.001)。男性(−8.4%[−9.3%对−7.6%]，P<；0.001)和女性(−9.5%[−10.8%对−8.3%]，P<；0.001)对死亡率的平均疗效无显著差异(P>0.05)。这坚持了年龄分层分析(≥85，65-84，45-，45岁)和敏感性分析，排除了紧急入院。除急性卒中、违抗医嘱和姑息性相遇外，pPCI对主要并发症的平均治疗效果与之相当。PPCI对住院时间的平均治疗效果没有差异，但在女性中，pPCI的费用增加比例更高。PPCI使男性和女性的住院死亡率有了类似的降低。尽管如此，在当代美国的实践中，风险调整后的pPCI比率在女性中仍然较低。
Women are less likely to receive primary percutaneous coronary intervention (pPCI) than men. A potential reason is risk aversion because of the worse outcomes with pPCI among women. However, whether pPCI is associated with a comparable mortality benefit in men and women remains unknown. We selected patients admitted with a principal diagnosis of ST‐segment–elevation myocardial infarction in the National Inpatient Sample (2016–2018). We used propensity‐score matching to calculate average treatment effects of pPCI for in‐hospital mortality, major complications, length of stay, and cost. As a sensitivity analysis, we used logit models followed by a marginal command to calculate the average marginal effect. We included 413 500 weighted hospitalizations (30.7% women, 69.3% men). Women had more comorbidities except smoking and prior sternotomy. Compared with men, women were less likely to undergo angiography (81.0% versus 87.0%; adjusted odds ratio [OR], 0.77; 95% CI, 0.74–0.81; P<0.001) or pPCI (74.0% versus 82.0%; adjusted OR, 0.76; 95% CI, 0.73–0.79; P<0.001). There were no significant differences in average treatment effects of pPCI on mortality between men (−8.4% [−9.3% to −7.6%], P<0.001), and women (−9.5% [−10.8% to −8.3%], P<0.001) (P interaction=0.16). This persisted in age‐stratified analyses (≥85, 65–84, 45–64, <45 years) and sensitivity analysis, excluding emergent admissions. The average treatment effects of pPCI on major complications were comparable except for acute stroke, leaving against medical advice, and palliative encounter. There were no differences in the average treatment effects of pPCI on length of stay, but the proportional increase in cost with pPCI was higher in women. pPCI results in a comparable reduction in in‐hospital mortality in men and women. Nonetheless, risk‐adjusted rates of pPCI remain lower in women in contemporary US practice.