Division of Cardiology, Department of Internal Medicine, Ulsan Medical Center, Ulsan Hospital, Ulsan, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Ulsan Medical Center, Ulsan Hospital, Ulsan, Republic of Korea; Department of Mechanical Engineering, Inha University, Incheon, Republic of Korea.
JACC Cardiovasc Interv. 2020 Jul 27;13(14):1669-1679. doi: 10.1016/j.jcin.2020.04.002. Epub 2020 Jun 24.
This study investigated the sex difference of long-term cardiovascular outcomes on coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients with deferred coronary artery lesions.
Coronary microvascular dysfunction is associated with poorer long-term outcomes. It can be assessed by CFR and the IMR.
The study prospectively enrolled 434 patients (133 women and 301 men) and analyzed CFR, IMR, fractional flow reserve, and quantitative coronary angiography. Clinical outcomes were assessed by major adverse cardiovascular event(s) (MACE) of cardiac death, myocardial infarction, and revascularization during 5 years of follow-up. The study protocol was approved by the Institutional Review Board or Ethics Committee at each participating center, and all patients provided written informed consent. The study protocol was in accordance with the Declaration of Helsinki.
Women had milder epicardial disease compared with men (fractional flow reserve: 0.91 [interquartile range (IQR): 0.87 to 0.96] vs. 0.90 [IQR: 0.86 to 0.95]; p = 0.037). IMR was similar between the sexes, but CFR was lower in women (2.69 [IQR: 2.08 to 3.90] vs. 3.20 [IQR: 2.20 to 4.31]; p = 0.006) due to a shorter resting mean transit time, whereas hyperemic mean transit times were similar. At 5-year follow-up, MACE was significantly lower in women compared with men (1.1% vs. 5.5%; p = 0.017). Sex, diabetes mellitus, and CFR were independent predictors for MACE for all patients. The risk of MACE was significantly higher in men with low versus high CFR (hazard ratio: 4.58; 95% confidence interval: 1.85 to 11.30; p = 0.011) which was not seen in women.
There was no sex difference in microvascular function by IMR. CFR was lower in women due to a higher resting coronary flow; however, long-term clinical outcomes in deferred lesions were better in women compared with men. (Clinical, Physiological and Prognostic Implication of Microvascular Status; NCT02186093).
本研究旨在探讨延迟性冠状动脉病变患者中，冠状动脉血流储备（CFR）和微血管阻力指数（IMR）的长期心血管结局的性别差异。
冠状动脉微血管功能障碍与较差的长期预后相关。可以通过 CFR 和 IMR 进行评估。
该研究前瞻性纳入了 434 名患者（133 名女性和 301 名男性），并分析了 CFR、IMR、血流储备分数和定量冠状动脉造影。通过 5 年随访期间的主要不良心血管事件（MACE）（心脏死亡、心肌梗死和血运重建）评估临床结局。该研究方案经每个参与中心的机构审查委员会或伦理委员会批准，所有患者均提供书面知情同意。该研究方案符合《赫尔辛基宣言》。
与男性相比，女性的表浅性疾病较轻（血流储备分数：0.91 [四分位距（IQR）：0.87 至 0.96] 比 0.90 [IQR：0.86 至 0.95]；p=0.037）。尽管 IMR 在两性之间相似，但 CFR 较低（2.69 [IQR：2.08 至 3.90] 比 3.20 [IQR：2.20 至 4.31]；p=0.006），这是由于静息平均通过时间较短，而充血平均通过时间相似。在 5 年随访时，女性的 MACE 发生率明显低于男性（1.1%比 5.5%；p=0.017）。性别、糖尿病和 CFR 是所有患者 MACE 的独立预测因素。在 CFR 较低的男性中，MACE 的风险明显高于 CFR 较高的男性（危险比：4.58；95%置信区间：1.85 至 11.30；p=0.011），而在女性中则没有这种情况。
在 IMR 方面，女性和男性的微血管功能没有性别差异。CFR 较低是由于静息状态下的冠状动脉血流较高所致；然而，与男性相比，延迟性病变的女性长期临床结局更好。（微血管状态的临床、生理和预后意义；NCT02186093）。
