Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, Copenhagen 2400, Denmark.
Eur Heart J. 2013 Nov;34(42):3294-303. doi: 10.1093/eurheartj/eht395. Epub 2013 Sep 26.
To evaluate probabilities of disability pension (DP) and premature exit from the workforce (PEW) in patients with stable angina symptoms and no obstructive coronary artery disease (CAD) at angiography compared with obstructive CAD and asymptomatic reference individuals.
We followed 4303 patients with no prior cardiovascular disease having a first-time coronary angiography (CAG) in 1998-2009 due to stable angina symptoms and 2772 reference individuals from the Copenhagen City Heart Study, all aged <65 years, through registry linkage until 2009 for DP and PEW. Five-year age-adjusted DP-free survival probabilities for reference individuals, patients with angiographically normal coronary arteries, angiographically diffuse non-obstructive CAD, 1 stenotic coronary vessel (1VD), 2VD, and 3VD, respectively, were 0.96, 0.88, 0.84, 0.82, 0.85, and 0.78 in women and 0.98, 0.90, 0.89, 0.89, 0.88, and 0.87 in men. Significant predictors of DP were higher age, angina symptoms, higher body mass index, diabetes, smoking, job status, non-marital status in men, lower income, lower educational level, and co-morbidity. Compared with the reference population, probabilities of DP and PEW were significantly increased in all patients with no gender difference (P > 0.2 for interaction). Thus, in pooled multivariable-adjusted analysis, patients referred to CAG for angina had a three-fold higher probability of DP and ~50% higher probability of PEW, with little difference between patients with angiographically normal coronary arteries, angiographically diffuse non-obstructive CAD, 1VD, 2VD, 3VD, the hazard ratios for DP being 2.7, 3.0, 3.3, 3.1, and 3.2 (all P < 0.001) and for PEW being 1.3, 1.4, 1.5, 1.6, and 1.6 (all P < 0.05).
Patients with angina symptoms and angiographically normal coronary arteries, diffuse non-obstructive CAD, or obstructive CAD at angiography have a three-fold increased probability of DP regardless of angiographic findings.
评估在稳定型心绞痛症状且无阻塞性冠状动脉疾病（CAD）的患者与阻塞性 CAD 和无症状参照个体相比，在因稳定型心绞痛症状而首次进行冠状动脉造影（CAG）的患者中，患有残疾抚恤金（DP）和过早退出劳动力（PEW）的概率。
我们对 4303 名无既往心血管疾病的患者进行了随访，这些患者在 1998 年至 2009 年间因稳定型心绞痛症状而首次进行 CAG，并对来自哥本哈根城市心脏研究的 2772 名参照个体进行了随访，所有患者年龄均<65 岁，通过登记处链接至 2009 年，以确定 DP 和 PEW。参考个体、血管造影正常冠状动脉患者、血管造影弥漫性非阻塞性 CAD、1 个狭窄的冠状动脉血管（1VD）、2VD 和 3VD 的 5 年年龄调整 DP 无生存概率分别为女性为 0.96、0.88、0.84、0.82、0.85 和 0.78，男性为 0.98、0.90、0.89、0.89、0.88 和 0.87。DP 的显著预测因素包括年龄较大、心绞痛症状、体重指数较高、糖尿病、吸烟、工作状况、男性未婚状态、收入较低、教育程度较低和合并症。与参考人群相比，所有患者的 DP 和 PEW 概率均显著增加，且无性别差异（交互作用 P>0.2）。因此，在多变量调整分析中，因心绞痛而行 CAG 检查的患者 DP 概率增加了两倍，PEW 概率增加了约 50%，血管造影正常冠状动脉、弥漫性非阻塞性 CAD、1VD、2VD、3VD 患者之间差异较小，DP 的危险比为 2.7、3.0、3.3、3.1 和 3.2（均 P<0.001），PEW 的危险比为 1.3、1.4、1.5、1.6 和 1.6（均 P<0.05）。
无论血管造影结果如何，有胸痛症状且血管造影正常冠状动脉、弥漫性非阻塞性 CAD 或阻塞性 CAD 的患者，DP 的概率增加了两倍。
