疑似冠心病患者冠状动脉粥样硬化进展和主要不良心脏事件的性别差异。
Sex differences in coronary atherosclerosis progression and major adverse cardiac events in patients with suspected coronary artery disease.
机构信息
Shandong Medical Imaging Research Institute, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Disease, Shandong University, #324 Jingwu Road, Jinan, 250021, PR China; Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing, 100037, PR China.
Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing, 100037, PR China.
出版信息
J Cardiovasc Comput Tomogr. 2017 Sep-Oct;11(5):367-372. doi: 10.1016/j.jcct.2017.07.002. Epub 2017 Jul 16.
BACKGROUND
Little is known about the influence of coronary atherosclerosis progression on the risk of major adverse cardiac events (MACE). Similarly, differences between men and women regarding atherosclerosis progression are poorly understood. The purpose of this study was to investigate the progression of coronary atherosclerosis by coronary CT angiography (coronary CTA) in men and women, and to evaluate its prognostic value regarding MACE.
METHODS
This study included 1046 patients with suspected coronary artery disease (CAD) who underwent serial coronary CTA because of new or worsening symptoms or because follow-up coronary CTA had been recommended by attending physicians. Coronary atherosclerosis was semi-quantitatively assessed as follows: three-vessel plaque score (TVPS), severe proximal plaque score (SPPS), segment stenosis score (SSS), segment involvement score (SIS), and coronary artery calcium score (CACS). Patients were followed-up regarding the occurrence of MACE, defined as cardiac death, coronary revascularization, nonfatal myocardial infarction and hospitalization due to unstable angina. Follow-up information was gathered by clinical visits or telephone contacts.
RESULTS
Follow-up was achieved in 953 (91.1%) patients (63.8% male; mean age, 53.9 ± 9.7 years) with a mean interval of 4.9 ± 1.1 years. MACE occurred in 132 (13.9%) patients. The average interscan time was 2.1 years. Compared with women, men had significantly higher progression of SPPS, SSS and SIS (6.6% vs. 3.5%, 28.0% vs. 18.3%, 26.6% vs. 16.8%, respectively, all P < 0.005). There was a strong association between the progression of SPPS as well as SSS and MACE, both for men (SPPS, HR:2.17, P < 0.001; SSS, HR:1.28, P = 0.023) and women (SPPS, HR:2.75, P < 0.001; SSS, HR:1.19, P = 0.027).
CONCLUSIONS
Progression of coronary atherosclerosis as determined by coronary CTA is higher in men than women, it is associated with the risk of future MACE.
背景
关于冠状动脉粥样硬化进展对主要不良心脏事件（MACE）风险的影响知之甚少。同样，男女之间关于动脉粥样硬化进展的差异也了解甚少。本研究的目的是通过冠状动脉 CT 血管造影（冠状动脉 CTA）来研究男性和女性的冠状动脉粥样硬化进展，并评估其对 MACE 的预后价值。
方法
本研究纳入了 1046 例疑似冠心病（CAD）患者，因新出现或加重的症状或因主治医生建议进行随访冠状动脉 CTA 而接受了连续冠状动脉 CTA。冠状动脉粥样硬化程度采用半定量方法评估：三血管斑块评分（TVPS）、严重近端斑块评分（SPPS）、节段狭窄评分（SSS）、节段受累评分（SIS）和冠状动脉钙评分（CACS）。通过临床随访或电话联系收集患者的 MACE（定义为心脏死亡、冠状动脉血运重建、非致命性心肌梗死和不稳定型心绞痛导致的住院）发生情况。
结果
在 953 例（91.1%）患者（63.8%为男性；平均年龄 53.9±9.7 岁）中进行了随访，平均随访间隔为 4.9±1.1 年。132 例（13.9%）患者发生了 MACE。两次扫描之间的平均时间为 2.1 年。与女性相比，男性的 SPPS、SSS 和 SIS 进展明显更高（分别为 6.6%比 3.5%、28.0%比 18.3%、26.6%比 16.8%，均 P<0.005）。男性和女性的 SPPS 和 SSS 进展均与 MACE 密切相关（SPPS，HR：2.17，P<0.001；SSS，HR：1.28，P=0.023）。
结论
冠状动脉 CTA 检测到的冠状动脉粥样硬化进展在男性中高于女性，与未来发生 MACE 的风险相关。
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