Symptom Presentation among Women with Suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA).
Symptom Presentation among Women with Suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA).
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DOI：
10.3390/jcm12185836
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发表时间：
2023-09-08
影响因子：
3.9
通讯作者：
Bairey Merz CN
中科院分区：
文献类型：
--
作者：
Taha YK;Dungan JR;Weaver MT;Xu K;Handberg EM;Pepine CJ;Bairey Merz CN
根据症状确定女性缺血性心脏病（IHD）是具有挑战性的。女性更有可能出现非心脏症状。超过50%的怀疑缺血的妇女在随访期间没有梗阻性冠状动脉疾病（因此，INOCA）和预后受损。我们的目的是确定在有临床证据的冠状动脉缺血妇女中具有预测能力的症状。我们从最初的WISE队列（NCT 00000554）中纳入了916名女性，她们因疑似缺血接受了冠状动脉造影，并完成了一份65项的WISE症状问卷。62% （n = 567）怀疑为INOCA。采用最佳子集方法检验Logistic回归模型，以Score χ2和AICc为基础确定INOCA的最佳预测模型。一个10变量的最佳拟合模型准确预测了INOCA （AUC 0.72, 95% CI 0.68, 0.75）。模型显示年龄≤55岁、左侧胸痛、胸部不适、颈部疼痛、心悸与INOCA呈独立正相关（OR bbb1） （p < 0.001 ~ 0.008）。在即将到来的厄运中观察到反比关系（OR < 1），下颌、左或双侧手臂和右手的疼痛被解释为与没有这些症状相关的INOCA （p≤0.001至0.023）。我们的最佳拟合模型在72%的时间内准确预测了基于年龄和症状表现的INOCA。虽然症状表现的异质性限制了这一未经验证的10变量模型的实用性，但它有望在未来对有症状性缺血证据的女性进行INOCA预测风险建模时考虑将症状纳入。
Identifying ischemic heart disease (IHD) in women based on symptoms is challenging. Women are more likely to endorse non-cardiac symptoms. More than 50% of women with suspected ischemia have no obstructive coronary disease (and thus, INOCA) and impaired outcomes during follow-up. We aimed to identify symptoms having predictive capacity for INOCA in women with clinical evidence of coronary ischemia. We included 916 women from the original WISE cohort (NCT 00000554) who had coronary angiography performed for suspected ischemia and completed a 65-item WISE symptom questionnaire. Sixty-two percent (n = 567) had suspected INOCA. Logistic regression models using a best subsets approach were examined to identify the best predictive model for INOCA based on Score χ2 and AICc. A 10-variable, best-fit model accurately predicted INOCA (AUC 0.72, 95% CI 0.68, 0.75). The model indicated that age ≤ 55 years, left side chest pain, chest discomfort, neck pain, and palpitations had independent, positive relationship (OR > 1) to INOCA (p < 0.001 to 0.008). An inverse relationship (OR < 1) was observed for impending doom, and pain in the jaw, left or bilateral arm, and right hand, interpreted as INOCA associated with the absence of these symptoms (p ≤ 0.001 to 0.023). Our best-fit model accurately predicted INOCA based on age and symptom presentation ~72% of the time. While the heterogeneity of symptom presentation limits the utility of this unvalidated 10-variable model, it has promise for consideration of symptom inclusion in future INOCA prediction risk modeling for women with evidence of symptomatic ischemia.
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DOI：
10.1016/j.whi.2017.07.002
发表时间：
2017-11
期刊：
Women's health issues : official publication of the Jacobs Institute of Women's Health
影响因子：
--
作者：
McSweeney JC;Cleves MA;Fischer EP;Pettey CM;Beasley B
通讯作者：
Beasley B
影响因子：
5.2
作者：
Bechsgaard, Daria Frestad;Gustafsson, Ida;Prescott, Eva
通讯作者：
Prescott, Eva
DOI：
10.1161/circoutcomes.109.928713
发表时间：
2010-11-01
影响因子：
6.9
作者：
Lichtman, Judith H.;Lorenze, Nancy P.;Krumholz, Harlan M.
通讯作者：
Krumholz, Harlan M.
影响因子：
4.8
作者：
Marroquin, OC;Holubkov, R;Reis, SE
通讯作者：
Reis, SE
影响因子：
0.6
作者：
Gitto, Mauro;Gentile, Francesco;Al-Lamee, Rasha
通讯作者：
Al-Lamee, Rasha