冠状动脉斑块程度与主要不良心血管事件风险之间的性别特异性关联：CONFIRM长期注册研究
Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry.
作者信息
Schulman-Marcus Joshua, Hartaigh Bríain Ó, Gransar Heidi, Lin Fay, Valenti Valentina, Cho Iksung, Berman Daniel, Callister Tracy, DeLago Augustin, Hadamitzky Martin, Hausleiter Joerg, Al-Mallah Mouaz, Budoff Matthew, Kaufmann Philipp, Achenbach Stephan, Raff Gilbert, Chinnaiyan Kavitha, Cademartiri Filippo, Maffei Erica, Villines Todd, Kim Yong-Jin, Leipsic Jonathon, Feuchtner Gudrun, Rubinshtein Ronen, Pontone Gianluca, Andreini Daniele, Marques Hugo, Shaw Leslee, Min James K
机构信息
Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY.
Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA.
出版信息
JACC Cardiovasc Imaging. 2016 Apr;9(4):364-372. doi: 10.1016/j.jcmg.2016.02.010.
OBJECTIVES
The purpose of this study was to examine sex-specific associations, if any, between per-vessel coronary artery disease (CAD) extent and the risk of major adverse cardiovascular events (MACE) over a 5-year study duration.
BACKGROUND
The presence and extent of CAD diagnosed by coronary computed tomography angiography (CTA) is associated with increased short-term mortality and MACE. Nevertheless, some uncertainty remains regarding the influence of sex on these findings.
METHODS
5,632 patients (mean age 60.2 ± 11.8 years, 36.5% women) from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry were followed for 5 years. Obstructive CAD was defined as ≥50% luminal stenosis in a coronary vessel. Using Cox proportional hazards models, we calculated the hazard ratio (HR) for incident MACE among women and men, defined as death or myocardial infarction.
RESULTS
Obstructive CAD was more prevalent in men (42% vs. 26%; p < 0.001), whereas women were more likely to have normal coronary arteries (43% vs. 27%; p < 0.001). There were a total of 798 incident MACE events. After adjustment, there was a strong association between increased MACE risk and nonobstructive CAD (HR: 2.16 for women, 2.56 for men; p < 0.001 for both), obstructive 1-vessel CAD (HR: 3.69 and 2.66; p < 0.001), 2-vessel CAD (HR: 3.92 and 3.55; p < 0.001), and 3-vessel/left main CAD (HR: 5.94 and 4.44; p < 0.001). Further exploratory analyses of atherosclerotic burden did not identify sex-specific patterns predictive of MACE.
CONCLUSIONS
In a large prospective coronary CTA cohort followed long-term, we did not observe an interaction of sex for the association between MACE risk and increased per-vessel extent of obstructive CAD. These findings highlight the persistent prognostic significance of anatomic CAD subsets as detected by coronary CTA for the risk of MACE in both women and men.
目的
本研究旨在探讨在为期5年的研究期间，每支血管的冠状动脉疾病（CAD）程度与主要不良心血管事件（MACE）风险之间是否存在性别特异性关联。
背景
通过冠状动脉计算机断层扫描血管造影（CTA）诊断的CAD的存在和程度与短期死亡率和MACE增加相关。然而，性别对这些结果的影响仍存在一些不确定性。
方法
对来自CONFIRM（冠状动脉CT血管造影临床结果评估：一项国际多中心研究）登记处的5632名患者（平均年龄60.2±11.8岁，36.5%为女性）进行了5年的随访。阻塞性CAD定义为冠状动脉血管中管腔狭窄≥50%。使用Cox比例风险模型，我们计算了女性和男性发生MACE的风险比（HR），MACE定义为死亡或心肌梗死。
结果
阻塞性CAD在男性中更为普遍（42%对26%；p<0.001），而女性更有可能冠状动脉正常（43%对27%；p<0.001）。共有798例MACE事件发生。调整后，MACE风险增加与非阻塞性CAD（女性HR：2.16，男性HR：2.56；两者p<0.001）、阻塞性单支血管CAD（HR：3.69和2.66；p<0.001）、双支血管CAD（HR：3.92和3.55；p<0.001）以及三支血管/左主干CAD（HR：5.94和4.44；p<0.001）之间存在强烈关联。对动脉粥样硬化负担的进一步探索性分析未发现预测MACE的性别特异性模式。
结论
在一个长期随访的大型前瞻性冠状动脉CTA队列中，我们未观察到MACE风险与阻塞性CAD每支血管程度增加之间的关联存在性别交互作用。这些发现突出了冠状动脉CTA检测到的解剖学CAD亚组对女性和男性MACE风险的持续预后意义。
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