Weiner D A, Ryan T J, Parsons L, Fisher L D, Chaitman B R, Sheffield L T, Tristani F E
Evans Medical Department of Clinical Research, Boston University Medical Center Hospital, MA 02118.
Am Heart J. 1995 Mar;129(3):465-70. doi: 10.1016/0002-8703(95)90269-4.
To evaluate the significance of silent myocardial ischemia during exercise testing in women compared to men, we analyzed the data on 1087 women and 3834 men who underwent exercise testing and coronary angiography from the Coronary Artery Surgery Study (CASS) registry. The patients were divided into three groups on the basis of the results of exercise testing: group 1, silent ischemia (253 women, 853 men); group 2, symptomatic ischemia (156 women, 1250 men); and group 3, no ischemia (678 women, 1731 men). The survival rate at 12 years for women was 80% for group 1, 75% for group 2, and 86% for group 3 (p = 0.0022); the survival rate for men was 69% for group 1, 69% for group 2, and 76% for group 3 (p < 0.001). In both men and women with silent ischemia, the 12-year survival rate was related to the severity of coronary artery disease (CAD) and ranged from 79% for women with one-vessel CAD to 46% for men with three-vessel CAD. Survival at 12 years was enhanced by coronary artery bypass graft surgery as compared to medical treatment in patients with silent ischemia and three-vessel CAD for men (61% vs 46%, respectively, p = 0.0014) but not for women (45% vs 50%, respectively, p = 0.98). These data suggest that silent ischemia in women and men adversely affects survival rate and that men may gain more benefit from coronary artery bypass graft surgery than women when three-vessel CAD is present.
为评估女性与男性运动试验期间无症状心肌缺血的意义，我们分析了冠状动脉手术研究（CASS）登记处1087名女性和3834名男性进行运动试验及冠状动脉造影的数据。根据运动试验结果将患者分为三组：第1组，无症状缺血（253名女性，853名男性）；第2组，有症状缺血（156名女性，1250名男性）；第3组，无缺血（678名女性，1731名男性）。第1组女性12年生存率为80%，第2组为75%，第3组为86%（p = 0.0022）；第1组男性生存率为69%，第2组为69%，第3组为76%（p < 0.001）。在无症状缺血的男性和女性中，12年生存率与冠状动脉疾病（CAD）严重程度相关，单支血管CAD的女性为79%，三支血管CAD的男性为46%。对于无症状缺血且三支血管CAD的患者，与药物治疗相比，冠状动脉旁路移植手术提高了男性12年生存率（分别为61%和46%，p = 0.0014），但对女性无此效果（分别为45%和50%，p = 0.98）。这些数据表明，男性和女性的无症状缺血均对生存率有不利影响，且存在三支血管CAD时，男性可能比女性从冠状动脉旁路移植手术中获益更多。
