Icahn School of Medicine at Mount Sinai, New York, New York, USA; Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
JACC Cardiovasc Imaging. 2022 Sep;15(9):1635-1644. doi: 10.1016/j.jcmg.2022.03.032. Epub 2022 Jun 15.
Coronary vasomotor dysfunction (defined by reduced myocardial blood flow reserve [MBFR]) is associated with high cardiac risk in both men and women in absence of significant coexisting epicardial disease. Whether there is a sex-specific difference in prognostic value of reduced MBFR in patients with a greater burden of coexisting epicardial atherosclerotic disease is not well understood.
The purpose of this study was to examine the association of sex, MBFR, and mortality in consecutive patients with suspected or known coronary artery disease undergoing positron emission tomography myocardial perfusion imaging.
Unique consecutive patients undergoing rubidium (Rb)-82 rest/stress positron emission tomography myocardial perfusion imaging from 2010-2016 were followed for a median of 3.2 years. Multivariable Cox models were built to describe the interaction of sex and MBFR on all-cause and cardiac death for the overall population and stratified by extent of calcified atherosclerosis (none: coronary artery calcium score = 0, subclinical: coronary artery calcium >0, clinical: prior myocardial infarction/percutaneous coronary intervention) and abnormal perfusion (no significant obstructive disease: summed stress score = 0, 1%-9.9%, and ≥10%) at baseline.
Among 12,594 patients, 52.8% were women. Compared with men, women had a lower prevalence of known coronary artery disease (16.5% vs 29.5%; P < 0.001) and were less likely to undergo revascularization after myocardial perfusion imaging (4.9% vs 9.7%; P < 0.001), but were more likely to have a reduced MBFR of <2 (56.2% vs 50.6%; P < 0.001). There were 1,699 (13.5%) all-cause and 490 (3.9%) cardiac deaths. In fully adjusted Cox models, reduced MBFR was independently associated with higher risk of death (HR per 0.1-U decrease: 1.09 [95% CI: 1.08-1.10]; P < 0.001), but female sex was not (HR: 0.95 [95% CI: 0.85-1.05]; P = 0.27). There was no significant interaction between sex and MBFR on death (P = 0.22) and cardiac death (P = 0.35) overall or in subgroups of patients with clinical, subclinical, and no atherosclerosis or across categories of perfusion abnormality at baseline.
The association between reduced MBFR and higher risk of all-cause and cardiac death did not differ by sex, regardless of extent of coexisting atherosclerosis or perfusion abnormality.
在没有明显的并发心外膜疾病的情况下，冠状动脉血管运动功能障碍（定义为心肌血流储备减少 [MBFR]）与男性和女性的高心脏风险相关。在并发心外膜动脉粥样硬化疾病负担较大的患者中，MBFR 降低的预后价值是否存在性别特异性差异尚不清楚。
本研究旨在探讨性别、MBFR 和死亡率之间的关系，研究对象为接受正电子发射断层扫描心肌灌注成像检查的疑似或已知冠心病的连续患者。
从 2010 年至 2016 年，连续接受铷（Rb）-82 静息/应激正电子发射断层扫描心肌灌注成像的独特连续患者，中位随访时间为 3.2 年。建立多变量 Cox 模型来描述性别和 MBFR 对所有原因和心脏死亡的相互作用，对总体人群和按钙化动脉粥样硬化程度（无：冠状动脉钙评分=0、亚临床：冠状动脉钙>0、临床：既往心肌梗死/经皮冠状动脉介入治疗）和基线时异常灌注（无显著阻塞性疾病：总和应激评分=0、1%-9.9%和≥10%）进行分层。
在 12594 名患者中，52.8%为女性。与男性相比，女性患有已知冠心病的比例较低（16.5%比 29.5%；P<0.001），且在心肌灌注成像后接受血运重建的可能性较小（4.9%比 9.7%；P<0.001），但 MBFR<2 的可能性较大（56.2%比 50.6%；P<0.001）。共有 1699 例（13.5%）发生全因死亡，490 例（3.9%）发生心脏性死亡。在完全调整的 Cox 模型中，MBFR 降低与死亡风险增加独立相关（每降低 0.1-U，HR：1.09[95%CI：1.08-1.10]；P<0.001），但女性性别并非如此（HR：0.95[95%CI：0.85-1.05]；P=0.27）。性别和 MBFR 与死亡（P=0.22）和心脏性死亡（P=0.35）之间没有显著的相互作用，无论是整体还是在有临床、亚临床或无动脉粥样硬化的患者亚组中，还是在基线时的灌注异常类别中都是如此。
无论并发心外膜动脉粥样硬化的程度或灌注异常如何，MBFR 降低与全因和心脏死亡风险增加之间的关联在性别上没有差异。
