Pagidipati Neha J, Hemal Kshipra, Coles Adrian, Mark Daniel B, Dolor Rowena J, Pellikka Patricia A, Hoffmann Udo, Litwin Sheldon E, Udelson James, Daubert Melissa A, Shah Svati H, Martinez Beth, Lee Kerry L, Douglas Pamela S
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
J Am Coll Cardiol. 2016 Jun 7;67(22):2607-16. doi: 10.1016/j.jacc.2016.03.523. Epub 2016 Apr 4.
Although risk stratification is an important goal of cardiac noninvasive tests (NITs), few contemporary data exist on the prognostic value of different NITs according to patient sex.
The goal of this study was to compare the results and prognostic information derived from anatomic versus stress testing in stable men and women with suspected coronary artery disease.
In 8,966 patients tested at randomization (4,500 to computed tomography angiography [CTA], 52% female; 4,466 to stress testing, 53% female), we assessed the relationship between sex and NIT results and between sex and a composite of death, myocardial infarction, or unstable angina hospitalization.
In women, a positive CTA (≥70% stenosis) was less likely than a positive stress test result (8% vs. 12%; adjusted odds ratio: 0.67). Compared with negative test results, a positive CTA was more strongly associated with subsequent clinical events than a positive stress test result (CTA-adjusted hazard ratio of 5.86 vs. stress-adjusted hazard ratio of 2.27; adjusted p = 0.028). Men were more likely to have a positive CTA than a positive stress test result (16% vs. 14%; adjusted odds ratio: 1.23). Compared with negative test results, a positive CTA was less strongly associated with subsequent clinical events than a positive stress test result in men, although this difference was not statistically significant (adjusted p = 0.168). Negative CTA and stress test results were equally likely to predict an event in both sexes. A significant interaction between sex, NIT type, and test result (p = 0.01) suggests that sex and NIT type jointly influence the relationship between test result and clinical events.
The prognostic value of an NIT result varies according to test type and patient sex. Women seem to derive more prognostic information from a CTA, whereas men tend to derive similar prognostic value from both test types.
尽管风险分层是心脏无创检查（NITs）的一个重要目标，但目前关于不同NITs根据患者性别所具有的预后价值的当代数据很少。
本研究的目的是比较在疑似冠心病的稳定男性和女性中，解剖学检查与负荷试验的结果及预后信息。
在8966例随机接受检查的患者中（4500例接受计算机断层扫描血管造影[CTA]，52%为女性；4466例接受负荷试验，53%为女性），我们评估了性别与NIT结果之间以及性别与死亡、心肌梗死或不稳定型心绞痛住院的综合情况之间的关系。
在女性中，CTA阳性（狭窄≥70%）的可能性低于负荷试验阳性结果（8%对12%；校正比值比：0.67）。与检查结果为阴性相比，CTA阳性与随后临床事件的关联比负荷试验阳性结果更强（CTA校正风险比为5.86，而负荷试验校正风险比为2.27；校正p = 0.028）。男性CTA阳性的可能性高于负荷试验阳性结果（16%对14%；校正比值比：1.23）。与检查结果为阴性相比，在男性中CTA阳性与随后临床事件的关联比负荷试验阳性结果弱，尽管这种差异无统计学意义（校正p = 0.168）。CTA和负荷试验结果为阴性在两性中预测事件的可能性相同。性别、NIT类型和检查结果之间存在显著交互作用（p = 0.01），表明性别和NIT类型共同影响检查结果与临床事件之间的关系。
NIT结果的预后价值因检查类型和患者性别而异。女性似乎从CTA中获得更多预后信息，而男性从两种检查类型中获得的预后价值相似。
