Cardiovascular Events in Women's Ischemia Syndrome Evaluation

描述(由申请人提供)：妇女缺血综合征评估(WISE)研究是一项成功和富有成效的四中心前瞻性研究，研究对象是临床转诊为冠状动脉造影术的女性，以评估暗示缺血的症状。它的主要目的是改进对缺血性心脏病的诊断测试，并探索女性特有的缺血性心脏病的病理生理学。1996年9月开始招聘936名妇女，到2000年3月及时完成招聘工作。为另外五年的后续行动提供了支持，我们的数据库于2006年3月关闭。关于这些妇女的丰富的纵向数据库是可用的。我们正在寻求资金，以执行国家死亡指数(NDI)搜索，以将死亡率随访延长到平均8年(最长10年)。患者姓名驻留在临床站点，但为了保密，不包括在协调中心的WISE数据库中。经验丰富的现场协调员将准备材料提交给NDI，并将结果发送给协调中心。更新的死亡率数据将被添加到WISE数据库并进行分析。我们将评估人口学史因素、荷尔蒙状况、基线诊断测试的心理社会结果和遗传因素作为死亡率的预测因素。心血管死亡率数据的扩展将更清楚地确定有和没有梗阻性疾病的缺血性女性长期死亡率的预测因素。通过另一项有针对性的分析，我们将开发一种简单、可重复性的血管造影技术来识别微血管功能障碍，方法是将TIMI帧计数与多普勒线测定的冠状动脉血流储备相关联，在怀疑有缺血但无明显冠状动脉疾病的WISE女性中，测量腺苷的反应。一种简单的诊断技术使临床医生能够针对这些妇女进行积极的药物治疗，目的是早期冠状动脉疾病和改善预后。与公共卫生相关：很多注意力集中在出现心脏病发作和心绞痛的男性和女性之间的差异上。女性缺血综合征评估(WISE)研究是一项成功和富有成效的前瞻性研究，研究对象是临床转诊为冠状动脉造影术的女性，以评估提示缺血的症状。WISE的目标是改进对缺血性心脏病的诊断测试，并探索女性特有的缺血性心脏病的病理生理学。国家死亡指数(NDI)搜索将用于将明智女性的死亡率随访延长至平均8年(最长10年)。经验丰富的现场协调员将准备材料提交给NDI，并将结果发送到协调中心，在那里更新的死亡率数据将被添加到WISE数据库并进行分析。利用我们现有的数据库，冠状动脉危险因素、激素状况、心理社会因素、遗传因素和诊断测试结果将被评估为长期死亡率的预测因素。L：\WISE\WISE R03\FINAL\Narative.doc

DESCRIPTION (provided by applicant): The Women's Ischemia Syndrome Evaluation (WISE) study has been a successful and productive four-center prospective study of women clinically referred for coronary angiography for evaluation of symptoms suggestive of ischemia. Its major aims were to improve diagnostic testing for ischemic heart disease and to explore female-specific ischemic heart disease pathophysiology. Initiated in September 1996, recruitment of 936 women was completed in a timely manner by March 2000. Support was awarded for an additional five years of follow-up, and our database was closed in March 2006. A rich longitudinal database on these women is available. We are seeking funding to perform a National Death Index (NDI) search to extend mortality follow-up to an average of eight years (maximum 10 years). Patient names reside at the clinical sites, but to maintain confidentiality, are not included in the WISE database at the coordinating center. Experienced site coordinators will prepare materials to submit to the NDI and send results to the coordinating center. Updated mortality data will be added to the WISE database and analyzed. We will evaluate demographic medical history factors, hormonal status, psychosocial results of baseline diagnostic testing and genetic factors as predictors of mortality. Extension of cardiovascular mortality data will more clearly define prognostic factors for long-term mortality in women with ischemia with and without obstructive disease. With an additional targeted analysis, we will develop a simple, reproducible, angiographic technique to identify micro-vascular dysfunction, by correlating TIMI Frame Count with Doppler Wire determined coronary flow reserve measured in response to adenosine in WISE women with suspected ischemia but no significant coronary artery disease. Availability of a simple diagnostic technique allows clinicians to target these women for aggressive medical therapy aimed at early coronary artery disease and improved prognosis. PUBLIC HEALTH RELEVANCE: Much attention has been focused on the differences between men and women presenting with heart attacks and angina pain. The Women's Ischemia Syndrome Evaluation (WISE) study has been a successful and productive prospective study of women clinically referred for coronary angiography for evaluation of symptoms suggestive of ischemia. The goals of WISE were to improve diagnostic testing for ischemic heart disease and to explore female-specific ischemic heart disease pathophysiology. A National Death Index (NDI) search will be used to extend mortality follow-up for WISE women to an average of eight years (maximum 10). Experienced site coordinators will prepare materials to submit to NDI and send results to the coordinating center where updated mortality data will be added to the WISE database and analyzed. Using our existing database, coronary risk factors, hormonal status, psychosocial, genetic factors, and results of diagnostic tests will be evaluated as predictors of long-term mortality. L:\WISE\WISE R03\FINAL\Narrative.doc