Sex associations and computed tomography coronary angiography-guided management in patients with stable chest pain
Sex associations and computed tomography coronary angiography-guided management in patients with stable chest pain
复制标题
DOI：
10.1093/eurheartj/ehz903
复制
发表时间：
2020-04-01
影响因子：
39.3
通讯作者：
Berry, Colin
中科院分区：
文献类型：
--
作者：
Mangion, Kenneth;Adamson, Philip D.;Berry, Colin
目的的相对好处的计算机断层扫描冠状动脉造影（CTCA）引导管理的妇女和男子与怀疑心绞痛由于冠心病（CHD）是不确定的。方法和结果在这一事后分析的开放标签平行组多中心试验，我们招募了4146例患者，从12个心脏病诊所怀疑心绞痛的评估在英国各地。我们将受试者随机（1：1）分配至单独标准治疗组或标准治疗加CTCA组。女性有典型胸痛症状者582例（32.0%），男性880例（37.9%），差异有显著性（P < 0.001）。在CTCA引导组中，更多女性的冠状动脉正常[386（49.6%）vs. 263（26.2%）]，阻塞性CHD较少[105（11.5%）vs. 347（29.8%）]。CTCA指导的策略导致更多的女性比男性被重新分类为没有CHD {19.2% vs. 13.1%;绝对风险差异，5.7 [95%置信区间（CI）：2.7-8.7，P < 0.001]}或由于CHD而有心绞痛[15.0% vs. 9.0%;绝对危险度差5.6（2.3-8.9，P = 0.001）]。中位随访4.8年后，CTCA引导的治疗与女性CHD死亡或非致死性心肌梗死风险降低相似[风险比（HR）0.50，95% CI 0.24-1.04]，（HR 0.63，95% CI 0.42-0.95; P交互作用= 0.572）。结论在增加CTCA后，女性比男性更容易发现冠状动脉正常。这导致更多的女性被重新归类为没有冠心病，导致更多的下游测试和治疗被取消。CTCA对女性和男性的预后益处相似。
Aims The relative benefits of computed tomography coronary angiography (CTCA)-guided management in women and men with suspected angina due to coronary heart disease (CHD) are uncertain.Methods and results In this post hoc analysis of an open-label parallel-group multicentre trial, we recruited 4146 patients referred for assessment of suspected angina from 12 cardiology clinics across the UK. We randomly assigned (1:1) participants to standard care alone or standard care plus CTCA. Fewer women had typical chest pain symptoms (n = 582, 32.0%) when compared with men (n = 880, 37.9%; P < 0.001). Amongst the CTCA-guided group, more women had normal coronary arteries [386 (49.6%) vs. 263 (26.2%)] and less obstructive CHD [105 (11.5%) vs. 347 (29.8%)]. A CTCA-guided strategy resulted in more women than men being reclassified as not having CHD {19.2% vs. 13.1%; absolute risk difference, 5.7 [95% confidence interval (CI): 2.7-8.7, P < 0.001]}or having angina due to CHD [15.0% vs. 9.0%; absolute risk difference, 5.6 (2.3-8.9, P = 0.001)]. After a median of 4.8 years follow-up, CTCA-guided management was associated with similar reductions in the risk of CHD death or non-fatal myocardial infarction in women [hazard ratio (HR) 0.50, 95% CI 0.24-1.04], and men (HR 0.63, 95% CI 0.42-0.95; P-interaction = 0.572).Conclusion Following the addition of CTCA, women were more likely to be found to have normal coronary arteries than men. This led to more women being reclassified as not having CHD, resulting in more downstream tests and treatments being cancelled. There were similar prognostic benefits of CTCA for women and men.