Izadnegahdar Mona, Mackay Martha, Lee May K, Sedlak Tara L, Gao Min, Bairey Merz C Noel, Humphries Karin H
From the Division of Cardiology (M.I., K.H.H.), School of Nursing (M.M.), and Vancouver General Hospital, Leslie Diamond Women's Heart Health Clinic (T.L.S.), University of British Columbia, Canada; Heart Centre (M.M.) and Providence Health Care Research Institute (M.M., M.K.L., K.H.H.), St. Paul's Hospital, British Columbia, Canada; BC Centre for Improved Cardiovascular Health, British Columbia, Canada (M.I., M.K.L., M.G., K.H.H.); Centre for Health Evaluation and Outcomes Research, Canada (M.M., K.H.H.); and Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.).
Circ Cardiovasc Qual Outcomes. 2016 Feb;9(2 Suppl 1):S26-35. doi: 10.1161/CIRCOUTCOMES.115.002483.
The joint contribution of sex, ethnicity, and initial clinical presentation to the long-term outcomes of patients undergoing coronary angiography for acute coronary syndrome (ACS) or stable angina, in whom there is angiographic evidence for obstructive coronary artery disease, remains unknown.
We conducted a population-based cohort study on 49 556 adult ACS or stable angina patients with angiographic evidence of obstructive coronary artery disease (≥ 50% stenosis) in British Columbia. The 2-year composite outcome was all-cause death and hospital readmissions for myocardial infarction, heart failure, cerebrovascular accident, or angina after the index angiography. Sex and ethnic differences in the composite outcome were examined by clinical presentation using the Cox proportional-hazards and logistic regression models. Overall, 25.6% were women, 9.5% were South Asians, 3.0% were Chinese, and 65.9% presented with ACS. Regardless of ethnicity, women were more likely than men to have adverse outcomes, but the magnitude of the sex difference was greater in the ACS patients (P(interaction) for sex and clinical presentation=0.03). Angina readmission accounted for 45% of the composite outcome and was the main component for all groups with the exception of Chinese women with ACS. Furthermore, women were more likely than men to be readmitted for angina (odds ratio [95% confidence interval], 1.13 [1.04-1.22]).
Higher rates of adverse events among women with obstructive coronary artery disease, regardless of ethnicity, as well as high rates of angina readmission, highlight the need for more targeted interventions to reduce the burden of angina because this presentation is clearly not benign.
对于因急性冠状动脉综合征（ACS）或稳定型心绞痛接受冠状动脉造影检查且有阻塞性冠状动脉疾病血管造影证据的患者，性别、种族和初始临床表现对其长期预后的联合影响尚不清楚。
我们对不列颠哥伦比亚省49556例有阻塞性冠状动脉疾病（狭窄≥50%）血管造影证据的成年ACS或稳定型心绞痛患者进行了一项基于人群的队列研究。2年综合结局为首次冠状动脉造影后全因死亡以及因心肌梗死、心力衰竭、脑血管意外或心绞痛再次入院。使用Cox比例风险模型和逻辑回归模型，按临床表现检查综合结局中的性别和种族差异。总体而言，25.6%为女性，9.5%为南亚人，3.0%为中国人，65.9%表现为ACS。无论种族如何，女性比男性更易出现不良结局，但ACS患者中性别差异的幅度更大（性别与临床表现的P（交互作用）=0.03）。心绞痛再次入院占综合结局的45%，是除患有ACS的中国女性外所有组的主要组成部分。此外，女性因心绞痛再次入院的可能性高于男性（优势比[95%置信区间]，1.13[1.04 - 1.22]）。
无论种族如何，患有阻塞性冠状动脉疾病的女性不良事件发生率较高，以及心绞痛再次入院率较高，凸显了需要采取更有针对性的干预措施来减轻心绞痛负担，因为这种表现显然并非良性。
