Zaman M Justin, Junghans Cornelia, Sekhri Neha, Chen Ruoling, Feder Gene S, Timmis Adam D, Hemingway Harry
Department of Epidemiology and Public Health, University College London, UK.
CMAJ. 2008 Sep 23;179(7):659-67. doi: 10.1503/cmaj.071763.
There is speculation that women and South Asian people are more likely than men and white people to report atypical angina and that they are less likely to undergo invasive management of angina. We sought to determine whether atypical symptoms of angina pectoris in women and South Asians impacted clinically important outcomes and clinical management.
We prospectively identified 2189 South Asian people and 5605 white people with recent-onset chest pain at 6 chest-pain clinics in the United Kingdom. We documented hospital admissions for acute coronary syndromes, coronary deaths as well as coronary angiography and revascularization procedures.
Atypical chest pain was reported by more women than men (56.5% vs 54.5%, p < 0.054) and by more South Asian patients than white patients (59.9% vs 52.5%, p < 0.001). Typical symptoms were associated with coronary death or acute coronary syndromes among women (hazard ratio [HR] 2.30, 95% CI 1.70-3.11, p < 0.001) but not among men (HR 1.23, 95% CI 0.96-1.57, p = 0.10). Typical symptoms were associated with coronary outcomes in both South Asian and white patients. Among those with typical symptoms, women (HR 0.76, 95% CI 0.63-0.92, p = 0.004) and South Asian patients (HR 0.52, 95% CI 0.41-0.67, p < 0.001) were less likely than men and white patients to receive angiography.
Compared to those with atypical chest pain, women and South Asian patients with typical pain had worse clinical outcomes. However, sex and ethnic background did not explain differences in the use of invasive procedures.
有推测认为，相较于男性和白人，女性及南亚人群更有可能报告非典型心绞痛，且接受心绞痛侵入性治疗的可能性更低。我们试图确定女性和南亚人心绞痛的非典型症状是否会影响临床重要结局及临床治疗。
我们前瞻性地在英国6家胸痛诊所识别出2189名近期发作胸痛的南亚人和5605名白人。我们记录了急性冠状动脉综合征的住院情况、冠状动脉死亡情况以及冠状动脉造影和血运重建手术情况。
报告非典型胸痛的女性多于男性（56.5%对54.5%，p<0.054），报告非典型胸痛的南亚患者多于白人患者（59.9%对52.5%，p<0.001）。典型症状与女性的冠状动脉死亡或急性冠状动脉综合征相关（风险比[HR]2.30，95%置信区间1.70 - 3.11，p<0.001），但与男性无关（HR 1.23，95%置信区间0.96 - 1.57，p = 0.10）。典型症状在南亚和白人患者中均与冠状动脉结局相关。在有典型症状的患者中，女性（HR 0.76，95%置信区间0.63 - 0.92，p = 0.004）和南亚患者（HR 0.52，95%置信区间0.41 - 0.67，p<0.001）接受血管造影的可能性低于男性和白人患者。
与有非典型胸痛的患者相比，有典型胸痛的女性和南亚患者临床结局更差。然而，性别和种族背景并不能解释侵入性治疗使用方面的差异。
