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Efectos de la edad y el sexo en los resultados clínicos después de la intervención coronaria percutánea en relación

Kyohei Yamaji1, Hiroki Shiomi1, Takeshi Morimoto1

  • 1From Division of Cardiology (K.Y., K.A., S.S.) and Division of Cardiovascular Surgery (M.H.), Kokura Memorial Hospital, Kitakyushu, Japan; Department of Cardiovascular Medicine (H.S., K.N., T.T., K.O., H.W., T. Kimura) and Department of Cardiovascular Surgery (R.S.), Kyoto University Graduate School of Medicine, Japan; Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan (T.M.); Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan (Y.F.); Division of Cardiology, Tenri Hospital, Japan (Y.N.); Department of Cardiology (K.K.) and Division of Cardiovascular Surgery (T. Komiya), Kurashiki Central Hospital, Japan; Division of Cardiology, Shizuoka City Shizuoka Hospital, Japan (T.O.); Division of Cardiology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan (M.N.); and Division of Cardiovascular Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan (N.N.).

Circulation
|March 25, 2016
PubMed
Resumen

La edad tiene un impacto significativo en el riesgo de mortalidad de la intervención coronaria percutánea (ICP) frente al injerto de derivación de la arteria coronaria (CABG), con mayores riesgos para los pacientes mayores. El sexo no mostró una diferencia significativa en el riesgo de mortalidad entre PCI y CABG.

Palabras clave:
grupos de edadDesvío de la arteria coronariaEnfermedad arterial coronariaIntervención coronaria por la pielel sexo

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Área de la Ciencia:

  • Medicina cardiovascular
  • Cardiología intervencionista
  • Cirugía cardíaca

Sus antecedentes:

  • La edad y el sexo son factores críticos que influyen en las decisiones de tratamiento entre la intervención coronaria percutánea (PCI) y el injerto de derivación de la arteria coronaria (CABG).
  • La comprensión de los resultados diferenciales de PCI frente a CABG basado en la demografía del paciente es esencial para optimizar la práctica clínica.

Objetivo del estudio:

  • Evaluar la asociación entre la edad y el sexo y el riesgo comparativo de mortalidad de PCI frente a CABG en pacientes con enfermedad coronaria de tres vasos.
  • Para determinar si la edad o el sexo modifican los resultados de las estrategias de revascularización.

Principales métodos:

  • Análisis de 5651 pacientes con enfermedad coronaria de los vasos triples del registro CREDO-Kyoto (cohorte-1 y cohorte-2).
  • Los pacientes fueron estratificados en tres grupos de edad: ≤65 años, 66-73 años y ≥74 años.
  • El riesgo comparativo de mortalidad entre PCI (n=3165) y CABG (n=2486) se evaluó utilizando ratios de riesgo ajustados (HR) e intervalos de confianza (IC).

Principales resultados:

  • Se observó un aumento significativo en el riesgo de mortalidad por PCI en relación con la CABG en pacientes de ≥74 años (HR, 1,40; IC del 95%, 1,10-1,79; P=0,006).
  • Los riesgos de mortalidad fueron neutrales para los pacientes ≤65 años (RH, 1,05; IC del 95%, 0,73-1,53; P=0,78) y de 66 a 73 años (RH, 1,03; IC del 95%, 0,78-1,36; P=0,85), con una interacción significativa por edad (P=0,003).
  • El PCI mostró un riesgo significativo de mortalidad excesiva en los hombres (RH, 1,24; IC del 95%, 1,03 a 1,50; P=0,02) y una tendencia en las mujeres (RH, 1,34; IC del 95%, 0,98 a 1,84; P=0,07), sin interacción significativa por sexo (P=0,40).

Conclusiones:

  • La edad es un factor significativo que modifica el riesgo de mortalidad de la PCI en comparación con la CABG, con pacientes mayores (≥74 años) experimentando mayores riesgos con la PCI.
  • Los grupos de edad más jóvenes (≤73 años) mostraron riesgos de mortalidad neutrales entre PCI y CABG.
  • No se encontraron diferencias significativas relacionadas con el sexo en la comparación del riesgo de mortalidad entre PCI y CABG.