Gehrie Erika R, Reynolds Harmony R, Chen Anita Y, Neelon Brian H, Roe Matthew T, Gibler W Brian, Ohman E Magnus, Newby L Kristin, Peterson Eric D, Hochman Judith S
New York University School of Medicine, New York, NY, USA.
Am Heart J. 2009 Oct;158(4):688-94. doi: 10.1016/j.ahj.2009.08.004.
Women with non-ST-segment elevation myocardial infarction (NSTEMI) who undergo coronary angiography have no obstructive coronary lesions more often than men. Sex-specific characteristics and outcomes of patients without obstructive coronary artery disease (CAD) have not been described previously.
Using data from NSTEMI patients enrolled in CRUSADE from 2001 to 2005, we evaluated differences in clinical features and in-hospital outcomes between men and women with no obstructive CAD.
After excluding patients with missing catheterization and sex data (n = 1,494), previous coronary artery bypass grafting or percutaneous coronary intervention (47,907), catheterization contraindications (n = 6,588), and missing obstructive CAD status (n = 1,565), there were 55,514 patients (68.4%) with NSTE acute coronary syndromes (ACS) who underwent angiography (among women, 62.1% [21,294/34,290], and among men, 73% [34,220/46,875]; P < .001). Among these, a total of 5,538 patients (10.0%) had nonnonobstructive CAD-15.1% (3,221/21,294) of women and 6.8% (2,317/34,220) of men (P < .0001). In patients without obstructive CAD, women were as likely as men to have MI (troponin elevation in 89% vs 87%, P = .37). Women and men were equally likely to have larger troponin elevations (58.9% vs 58.6% with troponin >5x upper limit of normal, P = .69, respectively). In NSTEMI patients without obstructive CAD, in-hospital death (0.6% women vs 0.7% men) and cardiogenic shock (1.0% women vs 0.7% men) were infrequent.
Among NSTE ACS patients undergoing coronary angiography, absence of obstructive CAD is more common in women than men. Although nonobstructive CAD was twice as common among women with NSTEMI, sex differences in characteristics and outcomes were similar to those found with obstructive CAD. Unadjusted in-hospital outcomes of NSTEMI patients with nonobstructive CAD are favorable in both sexes. Whether the underlying pathophysiology of NSTE ACS without documentation of obstructive CAD is different between women and men requires further study.
接受冠状动脉造影的非ST段抬高型心肌梗死（NSTEMI）女性患者无阻塞性冠状动脉病变的情况比男性更为常见。既往未描述无阻塞性冠状动脉疾病（CAD）患者的性别特异性特征及预后。
利用2001年至2005年纳入CRUSADE研究的NSTEMI患者的数据，我们评估了无阻塞性CAD的男性和女性在临床特征及住院期间预后方面的差异。
在排除导管插入术及性别数据缺失的患者（n = 1494）、既往冠状动脉旁路移植术或经皮冠状动脉介入治疗患者（47907例）、导管插入术禁忌证患者（n = 6588）以及阻塞性CAD状态缺失患者（n = 1565）后，有55514例NSTE急性冠状动脉综合征（ACS）患者接受了血管造影（女性中占62.1%[21294/34290]，男性中占73%[34220/46875]；P <.001）。其中，共有5538例患者（10.0%）有无阻塞性CAD，女性中占15.1%（3221/21294），男性中占6.8%（2317/34220）（P <.0001）。在无阻塞性CAD的患者中，女性发生心肌梗死的可能性与男性相似（肌钙蛋白升高者分别为89%和87%，P = 0.37）。女性和男性出现较高肌钙蛋白升高的可能性相同（肌钙蛋白>正常上限5倍者分别为58.9%和58.6%，P = 0.69）。在无阻塞性CAD的NSTEMI患者中，住院死亡（女性为0.6%，男性为0.7%）和心源性休克（女性为1.0%，男性为0.7%）并不常见。
在接受冠状动脉造影的NSTE ACS患者中，无阻塞性CAD在女性中比男性更常见。尽管无阻塞性CAD在NSTEMI女性中是男性的两倍，但特征及预后方面的性别差异与阻塞性CAD患者相似。无阻塞性CAD的NSTEMI患者未经调整的住院预后在两性中均较好。无阻塞性CAD记录的NSTE ACS的潜在病理生理学在女性和男性之间是否不同需要进一步研究。
