Angina with "normal" coronary arteries: Sex differences in outcomes
Angina with "normal" coronary arteries: Sex differences in outcomes
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DOI：
10.1016/j.ahj.2007.10.019
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发表时间：
2008-02-01
影响因子：
4.8
通讯作者：
Pilote, Louise
中科院分区：
文献类型：
--
作者：
Flumpbries, Karin H.;Pu, Aihua;Pilote, Louise
研究背景：一些研究表明，女性非阻塞性冠心病患者有较高的后续检查率、因复发性胸痛再住院率和重复冠状动脉造影率。这一发现的性别特异性尚不清楚。因此，我们进行了一项评估的性别差异，在再住院的急性冠状动脉综合征（ACS）或胸痛的患者与“血管造影正常”coronaries.Methods回顾性队列研究，采用前瞻性收集的血管造影和临床数据的所有患者在不列颠哥伦比亚省，加拿大，结果32856例首次心导管检查时疑有缺血性心脏病但冠状动脉造影正常者7.1%的男性和23.3%的女性血管造影正常（P <0.001）。在血管造影正常的患者中，女性比男性年龄更大，更容易出现高血压、既往卒中、慢性阻塞性肺疾病和外周血管疾病，但加拿大心血管学会心绞痛分级不因性别而异。1年内，1.0%的患者死亡（19名女性，18名男性，P = 0.27），0.6%的患者发生卒中（13名女性，9名男性，P = 0.91）。与男性相比，女性因ACS或胸痛需要导管插入术而再次入院的比例明显较高（调整后OR 4.06;结论：在一个当代的、基于人群的队列中，冠状动脉造影正常的女性在180天内因ACS/胸痛再次入院的可能性是男性的4倍以上。观察到的性别差异具有重要的社会和经济意义，并表明传统的诊断方法可能不适合女性。
Background Several studies have demonstrated that women with nonobstructive coronary disease have a high rate of subsequent investigations, rehospitalizations for recurrent chest pain, and repeat coronary angiography. The sex specificity of this finding is unclear. We therefore undertook an evaluation of sex differences in rehospitalization for acute coronary syndrome (ACS) or chest pain in patients with "angiographically normal" coronaries.Methods A retrospective cohort study using prospectively collected angiographic and clinical data on all patients in British Columbia, Canada, presenting for their first cardiac catheterization with suspected ischemic heart disease but angiographically normal coronaries.Results Among 32856 patients, 7.1% of men versus 23.3% of women were angiographically normal (P < .001). Among angiographically normal patients, women were older and more likely to present with hypertension, prior stroke, chronic obstructive pulmonary disease, and peripheral vascular disease than men, but Canadian Cardiovascular Society class of angina did not vary by sex. Within 1 year, 1.0% died, (19 women, 18 men, P = .27) and 0.6% had a stroke (13 women, 9 men, P = .91). Readmission to hospital for ACS or chest pain requiring catheterization was significantly higher in women compared to men (adjusted OR 4.06; 95% CI 1.15-14.31).Conclusions In a contemporary, population-based cohort presenting for cardiac catheterization for suspected ischemia, women with angiographically normal coronaries were >4 times more likely to be readmitted to hospital for ACS/chest pain within 180 days compared to men. The observed sex difference has important social and economic implications and suggests that traditional diagnostic methods may not be optimal for women.