德国疑似慢性冠状动脉综合征患者冠状动脉造影指南依从性的性别差异：来自ENLIGHT-KHK试验的见解

Sex differences in guideline adherence for coronary angiography in patients with suspected chronic coronary syndrome in Germany: insights from the ENLIGHT-KHK trial.

作者信息

Kentenich Hannah, Shukri Arim, Müller Dirk, Wein Bastian, Bruder Oliver, Stock Stephanie, Kampfer Yana

机构信息

Faculty of Medicine and University Hospital Cologne, Institute for Health Economics and Clinical Epidemiology, University of Cologne, Gleueler Straße 176-178 / II, 50935, Cologne, Germany.

Contilia Heart and Vascular Centre, Elisabeth-Hospital, Klara-Kopp-Weg 1, 45138, Essen, Germany.

出版信息

Clin Res Cardiol. 2025 May 6. doi: 10.1007/s00392-025-02655-y.

DOI:10.1007/s00392-025-02655-y

PMID:40327062

Abstract

BACKGROUND

For the management of acute coronary syndrome, literature shows lower healthcare providers' guideline adherence for women than for men. Since less is known about the management of chronic coronary syndrome (CCS), this study investigated patient-related sex differences in providers' guideline adherence for invasive coronary angiography (CA) performed in patients with suspected CCS.

METHODS

Using data from the German ENLIGHT-KHK trial, patients with suspected CCS who underwent a CA were analysed. To assess the association between patient sex and physicians' adherence to the German National Disease Management Guideline "Chronic coronary artery disease" of 2019, binary logistic regression models were developed. Covariates included age, symptoms, risk factors, comorbidities, and non-invasive testing and its results. To examine sex differences in predictors of guideline adherence, models were run separately for women and men.

RESULTS

Two hundred seventy-three women and three hundred eighty-six men were included (aged 67 ± 10 years). Physicians' guideline adherence for CA was lower for women than for men (19.4% vs. 30.1%, p = 0.002). CAs were less likely to be guideline-adherent for women with suspected CCS than men (OR 0.4, p < 0.05). Guideline adherence predictors differed between women and men. For example, men's predictors included non-invasive testing and its results, age, typical angina and smoking; of these, only a positive non-invasive test result had an impact for women.

CONCLUSION

Our results indicate a less guideline-adherent diagnostic workup of CA for women with suspected CCS than men. This might reflect a limited awareness of CCS in women and insufficiently sex-specific guideline recommendations.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00015638, Registered February 19, 2019; Universal Trial Number (UTN): U1111-1227-8055.

摘要

背景

在急性冠状动脉综合征的管理方面，文献表明医疗保健提供者对女性的指南依从性低于男性。由于对慢性冠状动脉综合征（CCS）的管理了解较少，本研究调查了在疑似CCS患者中进行侵入性冠状动脉造影（CA）时，医疗提供者在指南依从性方面与患者相关的性别差异。

方法

使用来自德国ENLIGHT-KHK试验的数据，对接受CA的疑似CCS患者进行分析。为了评估患者性别与医生对2019年德国国家疾病管理指南“慢性冠状动脉疾病”的依从性之间的关联，建立了二元逻辑回归模型。协变量包括年龄、症状、危险因素、合并症、无创检测及其结果。为了检查指南依从性预测因素中的性别差异，分别对女性和男性进行模型分析。

结果

纳入273名女性和386名男性（年龄67±10岁）。医生对女性CA的指南依从性低于男性（19.4%对30.1%，p = 0.002）。疑似CCS的女性进行的CA比男性更不可能符合指南要求（OR 0.4，p < 0.05）。女性和男性的指南依从性预测因素不同。例如，男性的预测因素包括无创检测及其结果、年龄、典型心绞痛和吸烟；其中，只有无创检测结果呈阳性对女性有影响。