Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
Biol Sex Differ. 2020 Nov 23;11(1):66. doi: 10.1186/s13293-020-00341-4.
Sex differences in clinical characteristics and prognosis of vasospastic angina (VA) have not been well elucidated. This study was performed to investigate sex-specific characteristics and predictors for long-term clinical outcomes in patients with VA.
We analyzed 1838 patients (55 years and 62% male) who were diagnosed with definite (n = 680) or intermediate (n = 1212) VA in ergonovine provocation test from a nation-wide VA registry. The primary study end-point was composite events including cardiac death, acute coronary syndrome, ventricular tachycardia or fibrillation, and atrioventricular block during clinical follow-up.
Male patients were younger, and there were more smokers and alcohol drinkers in male patients than in female patients. During the median follow-up period of 760 days (interquartile range, 336-1105 days), there were 73 cases (3.97%) of composite events. There was no sex difference in the occurrence of composite events (log-rank p = 0.649). Concomitant significant (≥ 50%) organic coronary stenosis was associated with worse clinical outcomes in both male (hazard ration [HR], 1.97; 95% confidence interval [CI], 1.01-3.85; p = 0.047) and female (HR, 3.26; 95% CI, 1.07-9.89; p = 0.037) patients. Obesity (body mass index ≥ 25 kg/m) was associated with better prognosis in female VA patients (HR, 0.22; 95% CI, 0.07-0.68; p = 0.008). Even when only patients with definite diagnosis of VA were considered, there was no significant sex difference in clinical outcomes (log-rank p = 0.876).
In VA patients, there were several different clinical characteristics according to sex; however, long-term clinical outcome was similar between sexes. Significant organic coronary stenosis in both sexes and low body mass index (< 25 kg/m) in females were associated with worse prognosis in VA patients.
血管痉挛性心绞痛（VA）的临床特征和预后存在性别差异，但尚未得到充分阐明。本研究旨在探讨 VA 患者的性别特异性特征和预测长期临床结局的因素。
我们分析了来自全国 VA 登记处的 1838 名（55 岁，62%为男性）接受麦角新碱激发试验诊断为明确（n=680）或中间型（n=1212）VA 的患者。主要研究终点是包括心脏性死亡、急性冠状动脉综合征、室性心动过速或颤动以及房室传导阻滞在内的复合事件。
男性患者较年轻，且男性患者中吸烟者和饮酒者的比例高于女性。在中位随访 760 天（四分位距 336-1105 天）期间，有 73 例（3.97%）发生复合事件。男女之间复合事件的发生率无统计学差异（log-rank p=0.649）。同时存在显著（≥50%）的器质性冠状动脉狭窄与男性（危险比[HR] 1.97；95%置信区间[CI] 1.01-3.85；p=0.047）和女性（HR 3.26；95% CI 1.07-9.89；p=0.037）患者的临床结局较差相关。肥胖（体重指数≥25 kg/m）与女性 VA 患者的良好预后相关（HR 0.22；95% CI 0.07-0.68；p=0.008）。即使仅考虑明确诊断为 VA 的患者，男女之间的临床结局也无显著差异（log-rank p=0.876）。
VA 患者的临床特征存在性别差异，但长期临床结局无性别差异。两性同时存在显著的器质性冠状动脉狭窄和女性的低体重指数（<25 kg/m）与 VA 患者的不良预后相关。
