恢复情况的差异：性别对年轻急性心肌梗死患者结局的影响（VIRGO）分类系统：年轻女性急性心肌梗死的分类法

The Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) Classification System: A Taxonomy for Young Women With Acute Myocardial Infarction.

作者信息

Spatz Erica S, Curry Leslie A, Masoudi Frederick A, Zhou Shengfan, Strait Kelly M, Gross Cary P, Curtis Jeptha P, Lansky Alexandra J, Soares Barreto-Filho Jose Augusto, Lampropulos Julianna F, Bueno Hector, Chaudhry Sarwat I, D'Onofrio Gail, Safdar Basmah, Dreyer Rachel P, Murugiah Karthik, Spertus John A, Krumholz Harlan M

机构信息

From Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S., J.P.C., A.J.L., J.F.L., R.P.D., K.M., H.M.K.), Section of General Internal Medicine, Department of Internal Medicine (C.P.G., S.I.C.), Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine (L.A.C., C.P.G., H.M.K.), Yale Cardiovascular Research Group, Department of Internal Medicine (A.J.L.), and Department of Emergency Medicine (G.D., B.S.), Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (E.S.S., S.Z., K.M.S., J.P.C., J.A.S.B.-F., J.F.L., H.B., R.P.D., K.M., H.M.K.); Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (L.A.C., H.M.K.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.); Division of Cardiology, Federal University of Sergipe, and the Clínica e Hospital São Lucas, Aracaju, Brazil (J.A.S.B.-F.); Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain (H.B.); and University of Kansas City-Missouri and Saint Luke's Mid America Heart Institute, Kansas City (J.A.S.).

出版信息

Circulation. 2015 Nov 3;132(18):1710-8. doi: 10.1161/CIRCULATIONAHA.115.016502. Epub 2015 Sep 8.

DOI:10.1161/CIRCULATIONAHA.115.016502

PMID:26350057

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4858327/

Abstract

BACKGROUND

Current classification schemes for acute myocardial infarction (AMI) may not accommodate the breadth of clinical phenotypes in young women.

METHODS AND RESULTS

We developed a novel taxonomy among young adults (≤55 years) with AMI enrolled in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study. We first classified a subset of patients (n=600) according to the Third Universal Definition of MI using a structured abstraction tool. There was heterogeneity within type 2 AMI, and 54 patients (9%; including 51 of 412 women) were unclassified. Using an inductive approach, we iteratively grouped patients with shared clinical characteristics, with the aims of developing a more inclusive taxonomy that could distinguish unique clinical phenotypes. The final VIRGO taxonomy classified 2802 study participants as follows: class 1, plaque-mediated culprit lesion (82.5% of women; 94.9% of men); class 2, obstructive coronary artery disease with supply-demand mismatch (2a: 1.4% women; 0.9% men) and without supply-demand mismatch (2b: 2.4% women; 1.1% men); class 3, nonobstructive coronary artery disease with supply-demand mismatch (3a: 4.3% women; 0.8% men) and without supply-demand mismatch (3b: 7.0% women; 1.9% men); class 4, other identifiable mechanism (spontaneous dissection, vasospasm, embolism; 1.5% women, 0.2% men); and class 5, undetermined classification (0.8% women, 0.2% men).

CONCLUSIONS

Approximately 1 in 8 young women with AMI is unclassified by the Universal Definition of MI. We propose a more inclusive taxonomy that could serve as a framework for understanding biological disease mechanisms, therapeutic efficacy, and prognosis in this population.

摘要

背景

目前的急性心肌梗死（AMI）分类方案可能无法涵盖年轻女性中广泛的临床表型。

方法与结果

我们在参与“恢复差异：性别对年轻AMI患者结局的作用（VIRGO）”研究的年轻成人（≤55岁）AMI患者中开发了一种新的分类法。我们首先使用结构化抽象工具根据心肌梗死的第三次通用定义对一部分患者（n = 600）进行分类。2型AMI存在异质性，54例患者（9%；包括412例女性中的51例）未分类。采用归纳法，我们反复将具有共同临床特征的患者分组，目的是开发一种更具包容性的分类法，以区分独特的临床表型。最终的VIRGO分类法将2802名研究参与者分类如下：1类，斑块介导的罪犯病变（82.5%的女性；94.9%的男性）；2类，伴有供需不匹配的阻塞性冠状动脉疾病（2a：1.4%的女性；0.9%的男性）和不伴有供需不匹配的阻塞性冠状动脉疾病（2b：2.4%的女性；1.1%的男性）；3类，伴有供需不匹配的非阻塞性冠状动脉疾病（3a：4.3%的女性；0.8%的男性）和不伴有供需不匹配的非阻塞性冠状动脉疾病（3b：7.0%的女性；1.9%的男性）；4类，其他可识别机制（自发性夹层、血管痉挛、栓塞；1.5%的女性，0.2%的男性）；5类，未确定分类（0.8%的女性，0.2%的男性）。