Sex-related differences in clinical outcomes and predictive factors in the very elderly patients with ACS undergoing PCI
BackgroundAs shown in previous studies, there may be sex-related differences in clinical outcomes in patients with acute coronary syndromes (ACS) after percutaneous coronary intervention (PCI). However, the benefits of PCI in very elderly ACS patients and the gender differences were poorly described...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.950165/full |
| _version_ | 1811206162124636160 |
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| author | Jia-li Wang Xiao-quan He Chun-yan Guo Hui Chen Hong-wei Li Hong-wei Li Hong-wei Li Shu-mei Zhao |
| author_facet | Jia-li Wang Xiao-quan He Chun-yan Guo Hui Chen Hong-wei Li Hong-wei Li Hong-wei Li Shu-mei Zhao |
| author_sort | Jia-li Wang |
| collection | DOAJ |
| description | BackgroundAs shown in previous studies, there may be sex-related differences in clinical outcomes in patients with acute coronary syndromes (ACS) after percutaneous coronary intervention (PCI). However, the benefits of PCI in very elderly ACS patients and the gender differences were poorly described and understood. We investigated the clinical characteristics and outcomes after PCI by sex stratification, and the predictive factors of major adverse cardiovascular and cerebrovascular events (MACCE) in this very elderly ACS cohort.MethodsA total of 1,676 consecutive ACS patients (50.2% women) aged ≥80 years old between January 2013 and May 2020 were recruited in this study. All patients were divided into four groups according to gender and treatment: male PCI (n = 321) and conservative management groups (n = 513), and female PCI (n = 283) and conservative management groups (n = 559). Clinical and coronary lesion characteristics were compared among four groups, also the clinical outcomes. MACCE and their predictive factors were assessed using Kaplan–Meier curve and Cox regression analysis.ResultsPCI procedures were conducted in 604 patients, and 1,072 were conservative management. Men were most likely to present with prior myocardial infarction (MI), peripheral artery disease, and chronic total occlusion (CTO); women had a higher prevalence of hypertension and dyslipidemia. The proportion of men receiving PCI procedures was significantly higher than that of women (38.5 vs. 33.6%, p = 0.038). Compared to conservative management, successful PCI significantly improved composite MACCE in both men (33.9 vs. 18.4%, p < 0.001) and women (27.9 vs. 20.8%, p = 0.026). There were no differences between sex in the improvement of clinical outcomes after PCI. In addition, age, ST-segment elevation myocardial infarction (STEMI), log N-terminal pro-brain natriuretic peptide (NT-proBNP), P2Y12 receptor antagonist, and β-blocker were independently associated with the incidence of MACCE after PCI tested by the Cox regression model, but not gender (male: hazard ratio (HR) 1.275, 95% confidence interval (CI) 0.853–1.905, p = 0.236).ConclusionIn this very elderly ACS cohort, men presented with more complex clinical conditions, and women were less likely to receive PCI treatment. Both women and men had similar benefits from the PCI procedure in the decrease of MACCE. |
| first_indexed | 2024-04-12T03:42:06Z |
| format | Article |
| id | doaj.art-73ac3a4a7c274e9bb4979a06c3c0b8f7 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-12T03:42:06Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-73ac3a4a7c274e9bb4979a06c3c0b8f72022-12-22T03:49:14ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-09-01910.3389/fcvm.2022.950165950165Sex-related differences in clinical outcomes and predictive factors in the very elderly patients with ACS undergoing PCIJia-li Wang0Xiao-quan He1Chun-yan Guo2Hui Chen3Hong-wei Li4Hong-wei Li5Hong-wei Li6Shu-mei Zhao7Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaDepartment of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaDepartment of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaDepartment of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaDepartment of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaDepartment of Internal Medical, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaBeijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, ChinaDepartment of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaBackgroundAs shown in previous studies, there may be sex-related differences in clinical outcomes in patients with acute coronary syndromes (ACS) after percutaneous coronary intervention (PCI). However, the benefits of PCI in very elderly ACS patients and the gender differences were poorly described and understood. We investigated the clinical characteristics and outcomes after PCI by sex stratification, and the predictive factors of major adverse cardiovascular and cerebrovascular events (MACCE) in this very elderly ACS cohort.MethodsA total of 1,676 consecutive ACS patients (50.2% women) aged ≥80 years old between January 2013 and May 2020 were recruited in this study. All patients were divided into four groups according to gender and treatment: male PCI (n = 321) and conservative management groups (n = 513), and female PCI (n = 283) and conservative management groups (n = 559). Clinical and coronary lesion characteristics were compared among four groups, also the clinical outcomes. MACCE and their predictive factors were assessed using Kaplan–Meier curve and Cox regression analysis.ResultsPCI procedures were conducted in 604 patients, and 1,072 were conservative management. Men were most likely to present with prior myocardial infarction (MI), peripheral artery disease, and chronic total occlusion (CTO); women had a higher prevalence of hypertension and dyslipidemia. The proportion of men receiving PCI procedures was significantly higher than that of women (38.5 vs. 33.6%, p = 0.038). Compared to conservative management, successful PCI significantly improved composite MACCE in both men (33.9 vs. 18.4%, p < 0.001) and women (27.9 vs. 20.8%, p = 0.026). There were no differences between sex in the improvement of clinical outcomes after PCI. In addition, age, ST-segment elevation myocardial infarction (STEMI), log N-terminal pro-brain natriuretic peptide (NT-proBNP), P2Y12 receptor antagonist, and β-blocker were independently associated with the incidence of MACCE after PCI tested by the Cox regression model, but not gender (male: hazard ratio (HR) 1.275, 95% confidence interval (CI) 0.853–1.905, p = 0.236).ConclusionIn this very elderly ACS cohort, men presented with more complex clinical conditions, and women were less likely to receive PCI treatment. Both women and men had similar benefits from the PCI procedure in the decrease of MACCE.https://www.frontiersin.org/articles/10.3389/fcvm.2022.950165/fullvery elderly patientsacute coronary syndromespercutaneous coronary interventionsex differencesmajor adverse cardiovascular and cerebrovascular events |
| spellingShingle | Jia-li Wang Xiao-quan He Chun-yan Guo Hui Chen Hong-wei Li Hong-wei Li Hong-wei Li Shu-mei Zhao Sex-related differences in clinical outcomes and predictive factors in the very elderly patients with ACS undergoing PCI Frontiers in Cardiovascular Medicine very elderly patients acute coronary syndromes percutaneous coronary intervention sex differences major adverse cardiovascular and cerebrovascular events |
| title | Sex-related differences in clinical outcomes and predictive factors in the very elderly patients with ACS undergoing PCI |
| title_full | Sex-related differences in clinical outcomes and predictive factors in the very elderly patients with ACS undergoing PCI |
| title_fullStr | Sex-related differences in clinical outcomes and predictive factors in the very elderly patients with ACS undergoing PCI |
| title_full_unstemmed | Sex-related differences in clinical outcomes and predictive factors in the very elderly patients with ACS undergoing PCI |
| title_short | Sex-related differences in clinical outcomes and predictive factors in the very elderly patients with ACS undergoing PCI |
| title_sort | sex related differences in clinical outcomes and predictive factors in the very elderly patients with acs undergoing pci |
| topic | very elderly patients acute coronary syndromes percutaneous coronary intervention sex differences major adverse cardiovascular and cerebrovascular events |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.950165/full |
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