Ospedale Manzoni, Lecco, Italy.
ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milano, Italy; Dept. of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
Int J Cardiol. 2018 May 15;259:8-13. doi: 10.1016/j.ijcard.2018.02.065. Epub 2018 Feb 21.
Early menopause has been associated with increased cardiovascular mortality, but prospective studies investigating outcomes of postmenopausal women with acute coronary syndromes (ACS) in relation to menopausal age are lacking.
We analyzed the 1-year outcome of 373 women with acute myocardial infarction enrolled in the Ladies ACS study. All patients underwent coronary angiography, with corelab analysis. Menopause questionnaires were administered during admission. Menopausal age below the median of the study population (50 years) was defined as "early menopause". The composite 1-year outcome included all-cause mortality, recurrent myocardial infarction and stroke.
The mean age at index ACS was 73 years (IQR 65-83) for women with early menopause, and 74 (IQR 65-80) for those with late menopause. Patients with early menopause had more prevalent chronic kidney disease (12.8% vs 5.9%, p = 0.03), whereas there were no differences in all other clinical characteristics, extent of coronary disease at angiography (as assessed by Gensini and SYNTAX scores), as well as interventional treatments. Within 1 year, women with late menopause had significantly better outcome as compared with those with early menopause (6.5% vs 15.3%, p = 0.007). At logistic regression analysis, late menopause was independently associated with better outcome (OR 0.28; 95% CI 0.12-0.67; p = 0.004). With each year's delay in the menopause the adjusted risk decreased by 12% (OR 0.88, 0.77-0.99, p = 0.040).
Despite comparable clinical and angiographic characteristics, women with late menopausal age experience better outcomes after an ACS as compared with those with early menopause.
绝经早期与心血管死亡率增加有关，但缺乏前瞻性研究调查与急性冠状动脉综合征（ACS）相关的绝经后女性的结局与绝经年龄的关系。
我们分析了 373 名急性心肌梗死女性患者的 1 年结局，这些患者均参与了 Ladies ACS 研究。所有患者均接受冠状动脉造影，采用核心实验室分析。在入院期间进行绝经问卷。绝经年龄低于研究人群中位数（50 岁）定义为“早绝经”。复合 1 年结局包括全因死亡率、复发性心肌梗死和卒中等。
早绝经女性 ACS 指数年龄的平均值为 73 岁（IQR 65-83），晚绝经女性为 74 岁（IQR 65-80）。早绝经患者更常见慢性肾脏病（12.8% vs. 5.9%，p=0.03），但其他所有临床特征、血管造影时的冠状动脉疾病程度（通过 Gensini 和 SYNTAX 评分评估）以及介入治疗均无差异。在 1 年内，晚绝经女性的结局明显优于早绝经女性（6.5% vs. 15.3%，p=0.007）。在逻辑回归分析中，晚绝经与更好的结局独立相关（OR 0.28；95%CI 0.12-0.67；p=0.004）。每延迟 1 年绝经，调整后的风险降低 12%（OR 0.88，0.77-0.99，p=0.040）。
尽管临床和血管造影特征相似，但与早绝经相比，ACS 后晚绝经女性的结局更好。
