Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women's Ischemia Syndrome Evaluation) study.
Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women's Ischemia Syndrome Evaluation) study.
复制标题
DOI：
10.1016/j.jacc.2010.01.054
复制
发表时间：
2010-06-22
影响因子：
24
通讯作者：
Merz, Noel Bairey
中科院分区：
文献类型：
--
作者：
Pepine, Carl J.;Anderson, David;Sharaf, Barry L.;Reis, Steven E.;Smith, Karen M.;Handberg, Eileen M.;Johnson, B. Delia;Sopko, George;Merz, Noel Bairey
我们研究了冠状动脉微血管功能障碍是否能预测有缺血症状和体征的女性随访期间的主要不良结局。冠状动脉反应性改变经常发生在疑似缺血的女性中，内皮依赖成分与不良结局有关。内皮非依赖性微血管冠状动脉反应性与不良结局之间的可能联系仍不确定。作为国家心脏，肺和血液研究所赞助的女性缺血综合征评估（WISE）的一部分，我们调查了189名女性在评估疑似缺血时冠状动脉内腺苷后主要不良结局与基线冠状动脉血流储备（CFR）之间的关系。在5.4年（平均）时，我们观察到CFR与主要不良结局（死亡、非致死性心肌梗死、非致死性中风或因心力衰竭住院）之间存在显著关联。探索性ROC分析发现，CFR <2.32是不良结局的最佳判别阈值（事件发生率26.7%,≥2.32事件发生率12.2%;p = 0.01）。较低的CFR与主要不良结局的风险增加相关（HR 1.16, 95% CI 1.04 ~ 1.30; p = 0.009）。这在152名无阻塞性冠状动脉疾病（CAD）的女性中也成立（HR 1.20, 95% CI 1.05 ~ 1.38; p = 0.008）。CFR显著提高了对冠心病血管造影严重程度和其他危险情况的不良后果的预测。在疑似有缺血和动脉粥样硬化危险因素的女性中，冠状动脉微血管对腺苷的反应性与冠心病严重程度和冠心病危险因素相比，可显著提高对主要不良结局的预测。这些发现表明，冠状动脉微血管代表了预测和限制女性不良后果的诊断和治疗策略的新靶点。
We investigated whether coronary microvascular dysfunction predicts major adverse outcomes during follow-up among women with signs and symptoms of ischemia. Altered coronary reactivity occurs frequently in women evaluated for suspected ischemia and the endothelium-dependent component is linked with adverse outcomes. Possible links between endothelium-independent microvascular coronary reactivity and adverse outcomes remain uncertain. As part of the National Heart, Lung and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE), we investigated relationships between major adverse outcomes and baseline coronary flow reserve (CFR) following intracoronary adenosine in 189 women referred to evaluate suspected ischemia. At 5.4 (mean) years, we observed significant associations between CFR and major adverse outcomes (death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure). An exploratory ROC analysis identified CFR <2.32 as the best discriminating threshold for adverse outcomes (event rate 26.7% and ≥2.32 event rate 12.2%; p = 0.01). Lower CFR was associated with increased risk for major adverse outcomes (HR 1.16, 95% CI 1.04 to 1.30; p = 0.009). This held true among the 152 women without obstructive coronary artery disease (CAD) (HR 1.20, 95% CI 1.05 to 1.38; p = 0.008). CFR significantly improved prediction of adverse outcomes over angiographic CAD severity and other risk conditions. Among women with suspected ischemia and atherosclerosis risk factors, coronary microvascular reactivity to adenosine significantly improves prediction of major adverse outcomes over angiographic CAD severity and CAD risk factors. These findings suggest coronary microvessels represent novel targets for diagnostic and therapeutic strategies to predict and limit adverse outcomes in women.
登录
查看更多内容
影响因子：
5.3
作者：
Nitenberg, A;Pham, I;Chemla, D
通讯作者：
Chemla, D
影响因子：
39.3
作者：
Johnson, B. Delia;Shaw, Leslee J.;Merz, C. Noel Bairey
通讯作者：
Merz, C. Noel Bairey
影响因子：
37.8
作者：
Halcox, JPJ;Schenke, WH;Quyyumi, AA
通讯作者：
Quyyumi, AA
影响因子：
37.8
作者：
Neglia, D;Michelassi, C;Parodi, O
通讯作者：
Parodi, O
影响因子：
4.8
作者：
Jeremias, A;Whitbourn, RJ;Yock, PG
通讯作者：
Yock, PG