Groepenhoff Floor, Eikendal Anouk L M, Rittersma Z H Saskia, Gijsberts Crystel M, Asselbergs Folkert W, Hoefer Imo E, Pasterkamp Gerard, Rutten Frans H, Onland-Moret N Charlotte, Den Ruijter Hester M
Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Front Cardiovasc Med. 2021 May 3;8:670843. doi: 10.3389/fcvm.2021.670843. eCollection 2021.
The prognosis of women and men with persistent anginal complaints and non-obstructed coronary arteries is impaired as compared with asymptomatic women and men. The increased healthcare burden in the hospital due to repeated coronary angiography in these women and men has been documented, yet little is known about the percentage of women and men who remain symptomatic and under care of the general practitioner in the years following a coronary angiographic outcome of non-obstructed coronary arteries. From the Utrecht Coronary Biobank study, including individuals who underwent a coronary angiography from 2011 to 2015 ( = 2,546, 27% women), we selected women and men with non-obstructed coronary arteries ( = 687, 39% women). This population was linked to the Julius General Practitioners Network (JGPN); a database with routine care data of general practitioners. For every individual with non-obstructed coronary arteries, we selected an asymptomatic non-referred age-, sex-, and general practitioner-matched individual from the JGPN. We compared the healthcare consumption of men and women with non-obstructed coronary arteries to these matched individuals. The McNemar's test was used for pairwise comparison, and sex differences were assessed using stratified analyses. The prevalence of non-obstructed coronary arteries was higher in women as compared with men (39 vs. 23%). During a median follow-up of 7 years [IQR 6.4-8.0], 89% of the individuals with non-obstructed coronary arteries (91% women and 87% men) visited their general practitioner for one or more cardiovascular consultations. This was compared to 34% of the matched individuals (89 vs. 34%, < 0.001). The consultations were most often for angina (equivalents) (57 vs. 11%, < 0.001) and heart failure (10 vs. 2%, = 0.015). In addition, they more often consulted the general practitioner for psychosocial complaints (31 vs. 15%, = 0.005). Findings were similar for women and men. A coronary angiographic outcome of non-obstructed coronary arteries is more common in women than in men. In the years following the coronary angiography, the majority of the population remains symptomatic. Both women and men with non-obstructed coronary arteries had higher health needs for angina, heart failure, and psychosocial complaints than matched asymptomatic individuals.
与无症状的女性和男性相比，有持续性心绞痛症状且冠状动脉无阻塞的女性和男性的预后较差。已有文献记载，这些女性和男性因反复进行冠状动脉造影而增加了医院的医疗负担，但对于冠状动脉造影结果显示冠状动脉无阻塞的女性和男性中，在随后几年仍有症状并由全科医生诊治的比例，人们知之甚少。在乌得勒支冠状动脉生物样本库研究中，纳入了2011年至2015年接受冠状动脉造影的个体（n = 2546，27%为女性），我们从中选取了冠状动脉无阻塞的女性和男性（n = 687，39%为女性）。该人群与朱利叶斯全科医生网络（JGPN）相关联，JGPN是一个包含全科医生常规护理数据的数据库。对于每一位冠状动脉无阻塞的个体，我们从JGPN中选取了一名年龄、性别和全科医生匹配的无症状未转诊个体。我们将冠状动脉无阻塞的女性和男性的医疗消耗与这些匹配个体进行了比较。采用McNemar检验进行配对比较，并使用分层分析评估性别差异。与男性相比，女性冠状动脉无阻塞的患病率更高（39%对23%）。在中位随访7年期间[四分位间距6.4 - 8.0]，89%的冠状动脉无阻塞个体（91%为女性，87%为男性）因一次或多次心血管问题就诊于全科医生。相比之下，匹配个体的这一比例为34%（89%对34%，P < 0.001）。就诊最常见的原因是心绞痛（等效症状）（57%对11%，P < 0.001）和心力衰竭（10%对2%，P = 0.015）。此外，他们因心理社会问题就诊于全科医生的频率也更高（31%对15%，P = 0.005）。女性和男性的结果相似。冠状动脉造影结果显示冠状动脉无阻塞在女性中比在男性中更常见。在冠状动脉造影后的几年里，大多数人群仍有症状。冠状动脉无阻塞的女性和男性在心绞痛、心力衰竭和心理社会问题方面的健康需求均高于匹配的无症状个体。
