Ferri Luca A, Morici Nuccia, Bassanelli Giorgio, Franco Nicoletta, Misuraca Leonardo, Lenatti Laura, Jacono Emilia Lo, Leuzzi Chiara, Corrada Elena, Aranzulla Tiziana C, Colombo Delia, Cagnacci Angelo, Prati Francesco, Savonitto Stefano
Ospedale Manzoni, Lecco, Italy.
Ospedale Niguarda, Milan, Italy.
Menopause. 2018 Jun;25(6):635-640. doi: 10.1097/GME.0000000000001064.
Vasomotor symptoms (VMS) during menopausal transition have been linked to a higher burden of cardiovascular risk factors, subclinical vascular disease, and subsequent vascular events. We aim to investigate the association of VMS with the extent of coronary disease and their prognostic role after an acute coronary syndrome.
The Ladies Acute Coronary Syndrome study enrolled consecutive women with an acute coronary syndrome undergoing coronary angiography. A menopause questionnaire was administered during admission. Angiographic data underwent corelab analysis. Six out of 10 enrolling centers participated in 1-year follow-up. Outcome data included the composite endpoint of all-cause mortality, recurrent myocardial infarction, stroke, and rehospitalization for cardiovascular causes within 1 year.
Of the 415 women with available angiographic corelab analysis, 373 (90%) had complete 1-year follow-up. Among them, 202 women had had VMS during menopausal transition. These women had the same mean age at menopause as those without VMS (50 years in both groups), but were younger at presentation (median age 71 vs 76 years; P < 0.001), despite a more favorable cardiovascular risk profile (chronic kidney dysfunction 4.5% vs 15.9%; P = 0.001; prior cerebrovascular disease 4.5 vs 12.2%; P = 0.018). Extent of coronary disease at angiography was similar between groups (mean Gensini score 49 vs 51; P = 0.6; mean SYNTAX score 14 vs 16; P = 0.3). Overall cardiovascular events at 1 year did not differ between groups (19% vs 22%; P = 0.5).
In postmenopausal women with an acute coronary syndrome, a history of VMS was associated with younger age at presentation, despite a lower vascular disease burden and similar angiographically defined coronary disease as compared with women without VMS. No difference could be found in terms of overall clinical outcomes. These results should be interpreted cautiously as all analyses were unadjusted and did not account for risk factor differences between women with and without a history of VMS.
围绝经期血管舒缩症状（VMS）与心血管危险因素负担加重、亚临床血管疾病及随后的血管事件有关。我们旨在研究VMS与冠心病程度的关联及其在急性冠脉综合征后的预后作用。
“女性急性冠脉综合征”研究纳入了连续的因急性冠脉综合征接受冠状动脉造影的女性。入院期间进行了一份绝经问卷的调查。血管造影数据进行了核心实验室分析。10个入组中心中有6个参与了为期1年的随访。结局数据包括1年内全因死亡、再发心肌梗死、中风以及因心血管原因再次住院的复合终点。
在415名有可用血管造影核心实验室分析的女性中，373名（90%）有完整的1年随访。其中，202名女性在围绝经期有VMS。这些女性绝经时的平均年龄与无VMS的女性相同（两组均为50岁），但发病时更年轻（中位年龄71岁对76岁；P<0.001），尽管心血管风险状况更有利（慢性肾功能不全4.5%对15.9%；P=0.001；既往脑血管疾病4.5%对12.2%；P=0.018）。两组血管造影时的冠心病程度相似（平均Gensini评分49对51；P=0.6；平均SYNTAX评分14对16；P=0.3）。1年时总的心血管事件在两组间无差异（19%对22%；P=0.5）。
在患有急性冠脉综合征的绝经后女性中，有VMS病史与发病时年龄较轻有关，尽管与无VMS的女性相比，血管疾病负担较低且血管造影定义的冠心病相似。在总体临床结局方面未发现差异。由于所有分析均未进行调整且未考虑有无VMS病史女性之间的危险因素差异，这些结果应谨慎解读。
