Background
Sex‐specific differences may influence prognosis after deferred revascularization following fractional flow reserve (
FFR
) measurement. This study sought to investigate the sex differences in long‐term prognosis of patients with deferred revascularization following
FFR
assessment.
Methods and Results
A total of 879 patients (879 vessels) with deferred revascularization with
FFR
>0.75 who underwent
FFR
and coronary flow reserve measurements were enrolled from 3 countries (Korea, Japan, and Spain). Long‐term outcomes were assessed in 649 men and 230 women by the patient‐oriented composite outcome (
POCO
, a composite of any death, any myocardial infarction, and any revascularization). We applied inverse‐probability weighting based on propensity scores to account for differences at baseline between women and men (age, hyperlipidemia, diabetes mellitus, diameter stenosis, lesion length, multivessel disease,
FFR
, coronary flow reserve. The median follow‐up duration was 1855 days (745–1855 days). Median
FFR
values were 0.88 (0.83–0.93) in men and 0.89 (0.85–0.94) in women, respectively. The occurrences of
POCO
were significantly high in men compared with that in women (10.5% versus 4.2%,
P
=0.007). Kaplan–Meier analysis revealed that women had a significantly lower risk of
POCO
(χ
2
=7.2,
P
=0.007). Multivariate
COX
proportional hazards regression analysis revealed that age, male, diabetes mellitus, diameter stenosis, lesion length, and coronary flow reserve were independent predictors of
POCO
. After applying
IPW
, the hazard ratio of males for
POCO
was 2.07 (95% CI, 1.07–4.04,
P
=0.032).
Conclusions
This large multinational study reveals that long‐term outcome differs between women and men in favor of women after
FFR
‐guided revascularization deferral.
Clinical Trial Registration
URL
:
http://www.ClinicalTrials.gov
. Unique identifier:
NCT
02186093.
El conocimiento de los factores pronósticos nos sirve para intuir la evolución de la enfermedad y calcular la supervivencia del paciente, considerar las posibilidades de recaída, estratificar los pacientes en diferentes grupos, valorar el beneficio de administrar un tratamiento y la respuesta al mismo, comparar diferentes tratamientos y diseñar estudios. Dentro de los tumores ginecológicos se engloban los tumores de ovario, los uterinos, los tumores de cérvix, de vagina y de vulva. Según sea el origen de la célula de la que deriva el tumor, éstos pueden ser de origen epitelial, mesenquimal o sarcomatoso y de origen germinal. Únicamente se han recogido los factores pronósticos de los tumores epiteliales ya que corresponden a más del 90% de los tumores ginecológicos. El pronóstico de cada uno de ellos va venir determinado, en primer lugar, por el estadio tumoral, que en los tumores ginecológicos se determina según las normas de la International Federation of Gynecology and Obstetricts (FIGO). Además del estadio, en el pronóstico influyen también las características intrínsecas de la paciente como son la edad o el estado general, el tipo histológico y ciertas características de la célula tumoral. Palabras clave. Factores pronósticos. Cáncer ginecológico. Estadiaje.
of therapy/no intervention, and again after another 6 to 8 weeks. Analysis was conducted using SPSS(X). Results: Voice therapy improved self-rated (F = 12.2, P = 0.001), and expert-rated voice quality (F = 17.5, P < 0.001). Therapy also improved one acoustic analysis parameter-shimmer (amplitude perturbation: F = 5.9, P < 0.01); however, this effect was not sustained at follow-up. There were no differences between the groups in psychological distress or quality of life over time. Conclusion: (1) Voice therapy for dysphonia is an effective treatment in terms of subjective reports. (2) Most objective acoustic parameters showed poor correlation with global reports of voice quality. (3) Voice therapy had surprisingly little impact on psychological distress or general health status.
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