早期介入治疗非st段抬高急性冠状动脉综合征疗效的年龄和性别差异：稳定患者的比较分析

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology Pub Date : 2025-03-29 DOI:10.1016/j.ajpc.2025.100984

Edina Cenko , Maria Bergami , Jinsung Yoon , Giuseppe Vadalà , Sasko Kedev , Jorgo Kostov , Marija Vavlukis , Elif Vraynko , Davor Miličić , Zorana Vasiljevic , Marija Zdravkovic , Alfredo R. Galassi , Olivia Manfrini , Raffaele Bugiardini

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引用次数: 0

摘要

目的以往的研究一直在努力明确NSTE-ACS患者基于初始治疗的性别特异性结局。我们研究了早期血运重建术（24小时）与保守策略对入院时稳定的NSTE-ACS患者的影响是否因性别和年龄而异。方法我们从ISACS-TC数据库中筛选出8905例诊断为非ST段抬高急性冠脉综合征（NSTE-ACS）的患者。排除有心脏骤停、血流动力学不稳定和严重室性心律失常的患者。最后的队列包括7589名患者。采用处理加权逆概率模型调整组间特征。主要结局指标为全因30天死亡率。采用95% ci的风险比（rr）。结果在确定的7589例NSTE-ACS患者中，2450例（32.3%）为女性。数据显示，与接受初始保守治疗的老年妇女相比，接受早期侵入性策略的老年妇女（65岁及以上）死亡率显著降低(3.0% vs 5.1%；RR: 0.57;95% CI: 0.32 - 0.99)相反，年轻女性在早期侵入性策略与死亡率降低之间没有显着关联(2.0%对0.9%；RR: 2.27;95% ci: 0.73 - 7.04)。对于男性，在总体人群中，年龄分层并没有明显改变观察到的早期侵入策略相对于保守方法的益处，两种老年人的死亡率都降低了(3.1%对5.7%；RR: 0.52;95% CI: 0.34 - 0.80)和更年轻的年龄组(0.8%对1.7%；RR: 0.46;95% ci: 0.22 - 0.94)。这些年龄和性别特异性死亡率模式在以非stemi存在或GRACE风险评分分层的亚组中没有显著变化[gt；140]。结论：在病情稳定的老年男性、女性和年轻男性NSTE-ACS患者中，早期冠状动脉血运重建与30天生存率的提高有关。在年轻女性中，它并没有赋予生存优势。需要进一步的研究来更准确地对年轻女性进行风险分层，以指导治疗策略

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Age and sex differences in the efficacy of early invasive strategy for non-ST-elevation acute coronary syndrome: A comparative analysis in stable patients

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Age and sex differences in the efficacy of early invasive strategy for non-ST-elevation acute coronary syndrome: A comparative analysis in stable patients

Objective

Previous works have struggled to clearly define sex-specific outcomes based on initial management in NSTE-ACS patients. We examined if early revascularization (<24 h) versus conservative strategy impacts differently based on sex and age in stable NSTE-ACS patients upon hospital admission.

Methods

We identified 8905 patients with diagnosis of non‐ST elevation acute coronary syndromes (NSTE-ACS) in the ISACS-TC database. Patients with cardiac arrest, hemodynamic instability, and serious ventricular arrhythmias were excluded. The final cohort consisted of 7589 patients. The characteristics between groups were adjusted using inverse probability of treatment weighting models. Primary outcome measure was all-cause 30-day mortality. Risk ratios (RRs) with their 95 % CIs were employed.

Results

Of the 7589 NSTE-ACS patients identified, 2450 (32.3 %) were women. The data show a notable reduction in mortality for the older women (aged 65 years and older) undergoing early invasive strategy compared to those receiving an initial conservative (3.0 % versus 5.1 %; RR: 0.57; 95 % CI: 0.32 – 0.99) Conversely, younger women did not exhibit a significant association between early invasive strategy and mortality reduction (2.0 % versus 0.9 %; RR: 2.27; 95 % CI: 0.73 – 7.04). For men, age stratification did not markedly alter the observed benefits of an early invasive strategy over a conservative approach in the overall population, with reduced death rates in both older (3.1 % versus 5.7 %; RR: 0.52; 95 % CI: 0.34 – 0.80) and younger age groups (0.8 % versus 1.7 %; RR: 0.46; 95 % CI: 0.22 – 0.94). These age and sex-specific mortality patterns did not significantly change within subgroups stratified by the presence of NSTEMI, or a GRACE risk score>140.

Conclusion

Early coronary revascularization is associated with improved 30-day survival in older men and women and younger men who present to hospital in stable conditions after NSTE-ACS. It does not confer a survival advantage in young women. Further studies are needed to more accurately risk-stratify young women to guide treatment strategies.