Jensen J, Eriksson S V, Lindvall B, Lundin P, Sylven C
Department of Cardiology, Huddinge Hospital, Sweden.
Coron Artery Dis. 2000 Oct;11(7):527-35. doi: 10.1097/00019501-200010000-00003.
Women have been considered to be at higher risk of complications relating to percutaneous transluminal coronary angioplasty (PTCA) than are men. One reason for this sex-related difference could be the ischemic response of myocardium during the procedure.
To investigate whether there are sex-related differences in ischemic response of myocardium during elective PTCA.
Consecutive patients (n = 192, of whom 48 were women), were subjected to vectorcardiography during the PTCA procedure. Vectorcardiographic variables, magnitude of ST-segment vector (ST-VM), and magnitude of ST-segment vector change (STC-VM) were studied.
Women were older (63 +/- 10 versus 56 +/- 10 years, P< 0.001) than men in our study and more often had diabetes mellitus and hypertension. Women less often had stents implanted (24 versus 50%, P < 0.01) and they were subjected to fewer balloon inflations (P < 0.001), with a total inflation time shorter than that for men (P< 0.001). Maximum STC-VM was 25% greater for women (P < 0.05). Women reported greater maximum pain (P < 0.05) and nitroglycerine was more frequently used for them during PTCA (P < 0.05). Occurrence of episodes of residual ischemic STC-VM (the difference between total number of episodes and number of balloon inflations) was more common for women (3 +/- 5 versus 1 +/- 3, P< 0.01). Duration of residual ischemic STC-VM episodes (the difference between total duration of episodes and duration of balloon inflations) was longer for women than it was for men (242 +/- 275 versus 148 +/- 233 s, P < 0.05). In a stepwise multivariate analysis and for a matched case-control group, episodes of residual STC-VM and duration of residual STC-VM episodes still indicated that there was an independent sex-related difference (P < 0.01 and P < 0.01, respectively).
Women more commonly develop vectorcardiographic signs of severe myocardial ischemia, more frequently experience episodes of ischemia and report more severe angina pectoris during elective PTCA than do men.
与经皮腔内冠状动脉成形术（PTCA）相关的并发症，女性被认为比男性风险更高。这种性别差异的一个原因可能是手术过程中心肌的缺血反应。
研究择期PTCA期间心肌缺血反应是否存在性别差异。
连续纳入患者（n = 192，其中48例为女性），在PTCA手术过程中进行心电向量图检查。研究心电向量图变量、ST段向量幅度（ST-VM）和ST段向量变化幅度（STC-VM）。
在我们的研究中，女性年龄比男性大（63±10岁对56±10岁，P<0.001），且更常患有糖尿病和高血压。女性植入支架的频率较低（24%对50%，P<0.01），球囊扩张次数较少（P<0.001），总扩张时间比男性短（P<0.001）。女性的最大STC-VM高25%（P<0.05）。女性报告的最大疼痛更剧烈（P<0.05），且在PTCA期间使用硝酸甘油的频率更高（P<0.05）。残余缺血性STC-VM发作（发作总数与球囊扩张次数之差）在女性中更常见（3±5对1±3，P<0.01）。女性残余缺血性STC-VM发作的持续时间（发作总持续时间与球囊扩张持续时间之差）比男性长（242±275秒对148±233秒，P<0.05）。在逐步多因素分析中，对于匹配的病例对照研究组，残余STC-VM发作和残余STC-VM发作持续时间仍表明存在独立的性别差异（分别为P<0.01和P<0.01）。
与男性相比，女性在择期PTCA期间更常出现严重心肌缺血的心电向量图征象，更频繁地经历缺血发作，并报告更严重的心绞痛。
