与BEST-CLI试验中的男性患者相比,女性患者的肢体截肢次数较少
Katharine L McGinigle1, Gheorghe Doros2, Olamide Alabi3
1Division of Vascular Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Journal of vascular surgery
|October 5, 2024
概括
与BEST-CLI试验中的男性相比,患有关键四肢缺血症 (CLI) 的女性患者在外科绕道后经历了更好的无截肢生存期. 对于患有CLI的女性,建议使用最佳导管的开放式外科绕道.
科学领域:
- 血管外科 血管外科
- 周围动脉疾病研究研究
- 临床试验分析
背景情况:
- 周围动脉疾病 (PAD) 的诊断和治疗率在女性中较低.
- 在PAD患者的短期和长期结果中存在性别差异.
- 危急肢体威胁性缺血症 (CLTI) 需要有效的重血管化策略.
研究的目的:
- 为了比较BEST-CLI试验中女性和男性患者的开放外科绕道与内血管治疗的结果.
- 专门在全女性队伍中分析重血管化结果.
- 确定最佳的治疗策略,以保护女性CLTI患者的肢体.
主要方法:
- 对BEST-CLI试验的第1和第2组的二次分析.
- 接受开放式外科绕道或内血管治疗的CLTI患者按性别分层.
- 评估结果包括主要截肢,重新干预,主要不良肢体事件 (MALE) 和全因死亡.
- 无变量和调整的考克斯回归模型用于结果评估.
主要成果:
- 女性占BEST-CLI队列的28% (n=519),与男性有不同的特征.
- 一年后,女性的主要四肢截肢率显著降低 (HR,0.70;P=.023),导致更好的无MALE生存率.
- 在全女性队列中,与内血管治疗相比,开放式外科绕道显示出更好的结果,再干预率较低 (10.5%vs24.8%;P<.001).
结论:
- 开放式手术绕道用单段大沙静脉 (SSGSV) 改善了无MALE存活率,与整体试验结果一致.
- 在BEST-CLI中,女性患者比男性患者有更好的1年无截肢生存率.
- 具有最佳导管的外科绕道是女性CLTI患者的首选治疗方法,有可能缓解与性别相关的肢体保护差异.
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