Mozaffarian Dariush, Bryson Chris L, Spertus John A, McDonell Mary B, Fihn Stephan D
Health Services Research & Development Center of Excellence, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Wash, USA.
Am Heart J. 2003 Dec;146(6):1015-22. doi: 10.1016/S0002-8703(03)00436-8.
Age, race, education, and diabetes have been associated with differences in anginal symptoms, treatments, and outcomes among outpatients with coronary artery disease (CAD), but there is little data on whether such characteristics affect relationships between anginal symptoms and mortality.
Using a prospective cohort design, we examined associations of anginal symptoms, as assessed by the Seattle Angina Questionnaire, with total mortality among 8908 outpatients with CAD to investigate whether this relationship is influenced by patient demographic or clinical characteristics. Potential effect modification was primarily assessed for age, race, education, and diabetes, and secondarily assessed for smoking, prevalent congestive heart failure (CHF), myocardial infarction, and coronary revascularization.
Over 2 years mean follow-up, there were 896 deaths. After adjustment for potential confounders, persons reporting greater physical limitation due to angina had higher mortality: 27% higher with mild limitation (hazard ratio [HR] 1.27, 95% CI 0.98-1.64), 61% higher with moderate limitation (HR 1.61, 95% CI 1.27-2.05), and 2.5-fold higher with the greatest limitation (HR 2.55, 95% CI 1.97-3.30), compared with little or no limitation (P for trend <.001). Anginal instability was also independently predictive of mortality. There was little evidence that these relationships varied by age, race, education, diabetes, smoking, or presence of CHF, prior myocardial infarction, or prior coronary revascularization (P for each interaction >.28). Anginal symptoms predicted higher mortality risk comparable to a decade of age difference, presence of diabetes, or presence of CHF.
Among outpatients with CAD, self-reported anginal symptoms consistently predict mortality irrespective of differences in age, race, education, or clinical comorbidities.
年龄、种族、教育程度和糖尿病与冠心病（CAD）门诊患者的心绞痛症状、治疗及预后差异有关，但关于这些特征是否影响心绞痛症状与死亡率之间的关系，数据较少。
采用前瞻性队列设计，我们通过西雅图心绞痛问卷评估了8908例CAD门诊患者的心绞痛症状与总死亡率之间的关联，以研究这种关系是否受患者人口统计学或临床特征的影响。主要评估了年龄、种族、教育程度和糖尿病对潜在效应的修正作用，次要评估了吸烟、既往充血性心力衰竭（CHF）、心肌梗死和冠状动脉血运重建对潜在效应的修正作用。
在平均2年的随访期内，有896例死亡。在调整潜在混杂因素后，因心绞痛报告身体限制更大的患者死亡率更高：与几乎没有或没有限制相比，轻度限制患者死亡率高27%（风险比[HR]1.27，95%置信区间0.98 - 1.64），中度限制患者死亡率高61%（HR 1.61，95%置信区间1.27 - 2.05），最大限制患者死亡率高2.5倍（HR 2.55，95%置信区间1.97 - 3.30）（趋势P值<.001）。心绞痛不稳定性也是死亡率的独立预测因素。几乎没有证据表明这些关系因年龄、种族、教育程度、糖尿病、吸烟或CHF、既往心肌梗死或既往冠状动脉血运重建的存在而有所不同（各交互作用P值>.28）。心绞痛症状预测的较高死亡风险与相差十岁、患有糖尿病或患有CHF相当。
在CAD门诊患者中，无论年龄、种族、教育程度或临床合并症存在何种差异，自我报告的心绞痛症状始终可预测死亡率。
