Department of Imaging, Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
Atherosclerosis. 2013 Sep;230(1):61-6. doi: 10.1016/j.atherosclerosis.2013.06.008. Epub 2013 Jul 4.
Symptom presentations suspicious for coronary artery disease (CAD) vary widely. While dyspnea is associated with worse prognosis than typical angina (TypAng) for patients referred for non-invasive CAD imaging, the relation of dyspnea vs. TypAng to adverse measures of CAD prognosis-including severity, burden, composition, and myocardium at risk-has not been examined.
We studied 1443 consecutive individuals without known CAD (mean 61 ± 13 years, 61.6% men) undergoing coronary computed tomographic angiography (CCTA) who presented with dyspnea (n = 170), TypAng (n = 249) or no dyspnea or TypAng (n = 1024). Multivariable logistic regression was performed to evaluate the association of dyspnea or TypAng to obstructive CAD (≥70% stenosis), plaque burden (total segments with plaque), composition (noncalcified, partially calcified) and location (proximal, mid, or distal location in a coronary artery).
By multivariable logistic regression, both dyspnea (OR1.9, 95% CI 1.1-3.3, p = 0.02) and TypAng (OR1.9, 95% CI 1.2-3.1, p = 0.01) were associated with obstructive CAD as compared to individuals without dyspnea or TypAng, while dyspnea (OR1.8, 95% CI 1.1-3.1, p = 0.02), but not TypAng (OR1.1, 95% CI 0.7-1.6, p = 0.76) was associated with plaque in the proximal portions of coronary arteries. Neither symptom type was associated with differences in plaque burden nor composition.
Both dyspnea and TypAng are associated with higher rates of obstructive CAD compared to those without dyspnea or TypAng, but only dyspnea is associated with coronary plaque in proximal vessel portions.
疑似冠心病（CAD）的症状表现差异很大。虽然呼吸困难与非侵入性 CAD 成像检查患者的典型心绞痛（TypAng）相比，预示着更差的预后，但呼吸困难与 TypAng 与 CAD 预后的不良指标——包括严重程度、负担、组成和危险心肌——之间的关系尚未被研究。
我们研究了 1443 名连续的无已知 CAD 患者（平均年龄 61 ± 13 岁，61.6%为男性），他们接受了冠状动脉计算机断层血管造影（CCTA）检查，表现为呼吸困难（n = 170）、TypAng（n = 249）或无呼吸困难或 TypAng（n = 1024）。采用多变量逻辑回归评估呼吸困难或 TypAng 与阻塞性 CAD（≥70%狭窄）、斑块负担（有斑块的总节段）、组成（非钙化、部分钙化）和位置（冠状动脉近端、中段或远端）的关系。
通过多变量逻辑回归，呼吸困难（OR1.9，95%置信区间 1.1-3.3，p = 0.02）和 TypAng（OR1.9，95%置信区间 1.2-3.1，p = 0.01）与阻塞性 CAD 相关，与无呼吸困难或 TypAng 的患者相比，而呼吸困难（OR1.8，95%置信区间 1.1-3.1，p = 0.02），但不是 TypAng（OR1.1，95%置信区间 0.7-1.6，p = 0.76）与冠状动脉近端斑块有关。两种症状类型与斑块负担或组成均无差异。
呼吸困难和 TypAng 与无呼吸困难或 TypAng 的患者相比，与更高的阻塞性 CAD 发生率相关，但只有呼吸困难与近端血管斑块有关。
