Kenkre Tanya S, Malhotra Pankaj, Johnson B Delia, Handberg Eileen M, Thompson Diane V, Marroquin Oscar C, Rogers William J, Pepine Carl J, Bairey Merz C Noel, Kelsey Sheryl F
From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (T.S.K., B.D.J., O.C.M., S.F.K.); Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (P.M., C.N.B.M.); Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville (E.M.H., C.J.P.); Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (D.V.T.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (O.C.M.); and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (W.J.R.).
Circ Cardiovasc Qual Outcomes. 2017 Dec;10(12). doi: 10.1161/CIRCOUTCOMES.116.003863.
The WISE study (Women's Ischemia Syndrome Evaluation) was a prospective cohort study of 936 clinically stable symptomatic women who underwent coronary angiography to evaluate symptoms and signs of ischemia. Long-term mortality data for such women are limited.
Obstructive coronary artery disease (CAD) was defined as ≥50% stenosis on angiography by core laboratory. We conducted a National Death Index search to assess the mortality of women who were alive at their final WISE contact date. Death certificates were obtained. All deaths were adjudicated as cardiovascular or noncardiovascular by a panel of WISE cardiologists masked to angiographic data. Multivariate Cox proportional hazards regression was used to identify significant independent predictors of mortality. At baseline, mean age was 58±12 years; 176 (19%) were non-white, primarily black; 25% had a history of diabetes mellitus, 59% hypertension, 55% dyslipidemia, and 59% had a body mass index ≥30. During a median follow-up of 9.5 years (range, 0.2-11.5 years), a total of 184 (20%) died. Of these, 115 (62%) were cardiovascular deaths; 31% of all cardiovascular deaths occurred in women without obstructive CAD (<50% stenosis). Independent predictors of mortality were obstructive CAD, age, baseline systolic blood pressure, history of diabetes mellitus, history of smoking, elevated triglycerides, and estimated glomerular filtration rate.
Among women referred for coronary angiography for signs and symptoms of ischemia, 1 in 5 died from predominantly cardiac pathogeneses within 9 years of angiographic evaluation. A majority of the factors contributing to the risk of death seem to be modifiable by existing therapies. Of note, 1 in 3 of the deaths in this cohort occurred in women without obstructive CAD, a condition often considered benign and without guideline-recommended treatments. Clinical trials are needed to provide treatment guidance for the group without obstructive CAD.
WISE研究（女性缺血综合征评估）是一项针对936名临床症状稳定的有症状女性进行的前瞻性队列研究，这些女性接受了冠状动脉造影以评估缺血的症状和体征。此类女性的长期死亡率数据有限。
核心实验室将阻塞性冠状动脉疾病（CAD）定义为血管造影显示狭窄≥50%。我们进行了一项国家死亡指数搜索，以评估在WISE最后一次随访时仍存活的女性的死亡率。获取了死亡证明。所有死亡均由一组对血管造影数据不知情的WISE心脏病专家判定为心血管死亡或非心血管死亡。采用多变量Cox比例风险回归来确定死亡率的显著独立预测因素。基线时，平均年龄为58±12岁；176名（19%）为非白人，主要是黑人；25%有糖尿病史，59%有高血压史，55%有血脂异常，59%的体重指数≥30。在中位随访9.5年（范围0.2 - 11.5年）期间，共有184名（20%）死亡。其中，115名（62%）为心血管死亡；所有心血管死亡中有31%发生在无阻塞性CAD（狭窄<50%）的女性中。死亡率的独立预测因素为阻塞性CAD、年龄、基线收缩压、糖尿病史、吸烟史、甘油三酯升高和估计肾小球滤过率。
在因缺血症状和体征而接受冠状动脉造影的女性中，五分之一在血管造影评估后的9年内主要因心脏病因死亡。大多数导致死亡风险的因素似乎可通过现有治疗方法进行调整。值得注意的是，该队列中有三分之一的死亡发生在无阻塞性CAD的女性中，这种情况通常被认为是良性的且没有指南推荐的治疗方法。需要进行临床试验以为无阻塞性CAD的人群提供治疗指导。
