Welch C C, Proudfit W L, Sheldon W C
Am J Cardiol. 1975 Feb;35(2):211-5. doi: 10.1016/0002-9149(75)90003-x.
In a consecutive series of 1,000 women under age 50 examined by coronary cinearteriography principally for evaluation of chest pain, 236 had at least 50 percent narrowing of one or more coronary arteries. The youngest, and the only patient who died, was 26 years old. The anterior descending coronary artery was the vessel most frequently involved; the right coronary artery was most often totally occluded. The amount of arterial involvement seemed to be related to the duration of symptoms. Only 10 percent of women with serum cholesterol levels under 200 mg/100 ml had significant coronary artery disease, whereas 44 percent of those with levels over 275 mg/100 ml had significant disease. Electrocardiographic evidence of myocardial infarction was uncommon in women with single vessel disease, but left ventriculograms disclosed that additional patients had areas of decreased contractility. Eleven of 46 women with electrocardiographically diagnosed myocardial infarction had no significant coronary artery disease. The cause of the electrocardiographic finding remained obscure in some. Although there was an excellent correlation of clinical diagnoses with arteriographic findings in women thought not to have angina pectoris, only half of those thought to have angina pectoris had significant coronary artery disease. This finding may be a major reason for recommending coronary arteriography for the evaluation of angina-like pain in women under age 50.
在连续1000例年龄在50岁以下、主要因胸痛接受冠状动脉造影检查的女性患者中，236例有一支或多支冠状动脉至少狭窄50%。最年轻的患者，也是唯一死亡的患者，为26岁。冠状动脉前降支是最常受累的血管；右冠状动脉最常完全闭塞。动脉受累程度似乎与症状持续时间有关。血清胆固醇水平低于200mg/100ml的女性中，只有10%有显著的冠状动脉疾病，而胆固醇水平高于275mg/100ml的女性中，44%有显著疾病。单支血管病变的女性中，心肌梗死的心电图证据并不常见，但左心室造影显示，另有一些患者有心肌收缩力下降的区域。46例经心电图诊断为心肌梗死的女性中，11例没有显著的冠状动脉疾病。部分患者心电图表现的原因仍不清楚。虽然在认为没有心绞痛的女性中，临床诊断与血管造影结果有很好的相关性，但在认为有心绞痛的女性中，只有一半有显著的冠状动脉疾病。这一发现可能是推荐对50岁以下女性的心绞痛样疼痛进行冠状动脉造影评估的主要原因。
