根据生物性别对TAVI的获取和后续结果进行比较
James Dargan1,2, Oliver Rees2, Laura Bijman2
1Cardiovascular Clinical Academic Group, City St George's University of London, London, UK james.dargan@stgeorges.nhs.uk.
Open heart
|November 14, 2025
概括
尽管女性占老年人大多数,但她们在跨导管大动脉植入 (TAVI) 程序中代表性不足. 然而,接受TAVI的女性的存活率更长,这表明心血管护理因素的复杂相互作用.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 欧洲指导方针将女性归类为心脏膜疾病管理中的"特殊群体".
- 本研究探讨了跨导管大动脉植入 (TAVI) 和其结果中女性代表性不足的问题.
- 检查TAVI获取和术后结果的基于性别的差异对于公平的心血管护理至关重要.
研究的目的:
- 评估国家和地方对TAVI的获取,按性别分层.
- 分析TAVI后的结果,包括存活率和主要心脏不良事件 (MACE),比较男性和女性.
- 确定导致TAVI利用和结果的潜在性别差异的因素.
主要方法:
- 从2013年至2023年在英国高等医疗中心对1049名连续接受TAVI治疗的患者进行了回顾性分析.
- 国家和地方TAVI统计数据与人口普查数据和英国心血管干预协会 (BCIS) 审计的比较.
- 主要结局包括全因死亡,MACE和TAVI后生存率,根据患者的性别进行分析.
主要成果:
- 女性占75岁以上人口的60%,但接受TAVI的频率低于男性 (46.8%,本地为53.2%;p<0.01).
- 接受TAVI的女性年龄较大,功能较差,脆弱性较高,跨膜梯度较大;男性有更多的并发病.
- 住院死亡率和MACE没有性别差异,但女性的中位生存时间明显长 (1728天 vs 1350天; p=0.02).
结论:
- 女性在TAVI程序中代表性不足,可能是由于多因素的原因,包括疾病识别,转诊和治疗实践的差异.
- 尽管基线风险因素较高 (年龄,虚弱,功能障碍),但女性在TAVI后的生存率有所改善.
- 女性性别是TAVI后生存率增加的预测因素,突出了对性别特异性心血管护理途径进一步调查的需要.
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