Frishman W H, Gomberg-Maitland M, Hirsch H, Catanese J, Furia-Palazzo S, Mueller H, Steingart R, Forman S
Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.
Clin Cardiol. 1998 Mar;21(3):184-90. doi: 10.1002/clc.4960210310.
Coronary artery disease (CAD) is a common problem in men and women; however, men and women with similar clinical presentations of myocardial ischemia may receive different revascularization treatments.
Using the data base of the Asymptomatic Cardiac Ischemia Pilot (ACIP) trial, this study was undertaken to compare by gender the baseline demographic data and the clinical outcome results in patients randomized to various treatments in the ACIP study.
This randomized trial compared three treatment regimens [pharmacologic management of angina, pharmacologic management of angina and ambulatory electrocardiographic (ECG) evidence of ischemia, and revascularization--that is, angioplasty and coronary artery bypass surgery], in patients with known CAD, positive stress ECG tests, and ECG evidence of ischemia during 48 h ambulatory monitoring. In all, 558 patients were randomized, 79 of whom were women (mean age: men 61.6 years, women 60.6 years) Ambulatory ECG evidence of ischemia, clinical events, that is, death, myocardial infarction, hospital admission for coronary events, and exercise performance were monitored.
Although of the same age as men at baseline, women had a higher prevalence of hypertension and diabetes. Women had less severe CAD by angiography and higher left ventricular ejection fractions. Men had longer exercise tolerance times on the treadmill. However, men and women had similar numbers and duration of ambulatory ECG ischemic abnormalities. Regarding revascularization, men more commonly underwent coronary artery bypass surgery (p = 0.025) while women underwent percutaneous transluminal coronary angioplasty more frequently (p = 0.10). Clinical outcomes were comparable in men and women, although the numbers of events were relatively small.
Men and women of comparable age manifest CAD with similar ischemic ECG abnormalities seen on both exercise tolerance and ambulatory ECG examinations. In ACIP, women tended to have more risk factors for CAD and less severity in anatomical disease, which may explain why women are less likely than men to have coronary bypass surgery.
冠状动脉疾病（CAD）在男性和女性中都是常见问题；然而，有相似心肌缺血临床表现的男性和女性可能会接受不同的血运重建治疗。
利用无症状性心脏缺血试验（ACIP）的数据，本研究旨在按性别比较ACIP研究中随机接受不同治疗的患者的基线人口统计学数据和临床结局结果。
这项随机试验比较了三种治疗方案[心绞痛的药物治疗、心绞痛的药物治疗和动态心电图（ECG）缺血证据、血运重建——即血管成形术和冠状动脉搭桥手术]，受试患者为已知患有CAD、运动心电图试验阳性且在48小时动态监测期间有ECG缺血证据者。共有558例患者被随机分组，其中79例为女性（平均年龄：男性61.6岁，女性60.6岁）。监测动态ECG缺血证据、临床事件，即死亡、心肌梗死、因冠状动脉事件住院以及运动表现。
尽管女性在基线时与男性年龄相同，但女性高血压和糖尿病的患病率更高。通过血管造影显示女性CAD病情较轻，左心室射血分数较高。男性在跑步机上的运动耐受时间更长。然而，男性和女性动态ECG缺血异常的数量和持续时间相似。关于血运重建，男性更常接受冠状动脉搭桥手术（p = 0.025），而女性更频繁地接受经皮冠状动脉腔内血管成形术（p = 0.10）。尽管事件数量相对较少，但男性和女性的临床结局相当。
年龄相当的男性和女性在运动耐量和动态ECG检查中表现出相似的缺血性ECG异常，提示患有CAD。在ACIP研究中，女性CAD的危险因素往往更多，解剖学疾病的严重程度较低，这可能解释了为什么女性比男性接受冠状动脉搭桥手术的可能性更小。
