Cardiovascular Clinical Research Center, New York University School of Medicine, NY 10016, USA.
Am Heart J. 2011 Apr;161(4):681-8. doi: 10.1016/j.ahj.2010.12.022.
The study aims to evaluate sex differences in extent and severity of coronary artery disease (CAD) and myocardial findings at autopsy among young people with fatal ischemic heart disease (IHD).
Women with acute coronary syndrome are less likely than men to display obstructive CAD at angiography. This suggests unique mechanisms of acute coronary syndrome exist in women or may reflect prehospital death of women with the most severe CAD.
Reports of autopsies by the Office of the Chief Medical Examiner of New York City on people aged 21 to 54 years who died between January 1, 2006, and December 31, 2008, were reviewed. A total of 639 cases of death due to atherosclerotic or arteriosclerotic cardiovascular disease according to the medical examiner were analyzed. Significant CAD was defined as ≥75% cross-sectional area stenosis in an epicardial vessel or ≥50% left main.
Women were less likely to have obstructive CAD (63% vs 77% of men, P = .002). There was pathologic evidence of myocardial infarction (MI) in 43% of cases, 17% of which had nonobstructive CAD. Frequency of MI did not vary by sex overall (38% of women vs 45% of men, P = .18) or among those without significant CAD (23% vs 29%, P = .45).
Among young people determined at autopsy to have died of IHD, fewer women had obstructive CAD, consistent with angiographic data in other IHD syndromes. Pathologic evidence of MI may exist in the absence of obstructive CAD.
本研究旨在评估在因缺血性心脏病（IHD）致死的年轻人中，性别对冠状动脉疾病（CAD）严重程度和心肌病变的影响。
与男性相比，患有急性冠状动脉综合征的女性在血管造影时出现阻塞性 CAD 的可能性较低。这表明女性中存在独特的急性冠状动脉综合征机制，或者可能反映了最严重 CAD 女性在发病前死亡。
回顾了 2006 年 1 月 1 日至 2008 年 12 月 31 日期间因 IHD 死亡且年龄在 21 至 54 岁之间的纽约市首席法医办公室尸检报告。共分析了 639 例归因于动脉粥样硬化或动脉硬化性心血管疾病的死亡病例。显著 CAD 定义为心外膜血管≥75%的横截面积狭窄或左主干≥50%。
女性发生阻塞性 CAD 的可能性较低（女性为 63%，男性为 77%，P =.002）。43%的病例存在心肌梗死（MI）的病理证据，其中 17%的病例存在非阻塞性 CAD。总体而言，MI 的发生率在女性（38%）和男性（45%）之间没有差异（P =.18），也没有在无显著 CAD 的人群中存在差异（23%比 29%，P =.45）。
在通过尸检确定死于 IHD 的年轻人中，与其他 IHD 综合征的血管造影数据一致，女性发生阻塞性 CAD 的比例较低。在无阻塞性 CAD 的情况下，可能存在 MI 的病理证据。
