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Association of Sex With Severity of Coronary Artery Disease, Ischemia, and Symptom Burden in Patients With Moderate or Severe Ischemia Secondary Analysis of the ISCHEMIA Randomized Clinical Trial

Reynolds, Harmony R. (författare)
NYU, Grossman Sch Med, New York, NY USA.
Shaw, Leslee J. (författare)
Weill Cornell Med, New York, NY USA.
Min, James K. (författare)
Weill Cornell Med, New York, NY USA.
visa fler...
Spertus, John A. (författare)
UMKC Sch Med, Kansas City, MO USA.
Chaitman, Bernard R. (författare)
St Louis Univ, Sch Med, St Louis, MO USA.
Berman, Daniel S. (författare)
Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA.
Picard, Michael H. (författare)
Massachusetts Gen Hosp, Boston, MA 02114 USA.;Harvard Med Sch, Boston, MA 02115 USA.
Kwong, Raymond Y. (författare)
Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA.
Bairey-Merz, C. Noel (författare)
Cedars Sinai Smidt Heart Inst, Los Angeles, CA USA.
Cyr, Derek D. (författare)
Duke Clin Res Inst, Durham, NC USA.
Lopes, Renato D. (författare)
Duke Clin Res Inst, Durham, NC USA.
Lopez-Sendon, Jose Luis (författare)
UAM, CIBER CV, Hosp Univ La Paz, Idipaz, Madrid, Spain.
Held, Claes, 1956- (författare)
Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi
Szwed, Hanna (författare)
Natl Inst Cardiol, Warsaw, Poland.
Senior, Roxy (författare)
Royal Brompton Hosp, Northwick Pk Hosp, London, England.
Gosselin, Gilbert (författare)
Montreal Heart Inst, Montreal, PQ, Canada.
Nair, Rajesh Gopalan (författare)
Govt Med Coll, Kerla, India.
Elghamaz, Ahmed (författare)
Royal Brompton Hosp, Northwick Pk Hosp, London, England.
Bockeria, Olga (författare)
Natl Res Ctr Cardiovasc Surg, Moscow, Russia.
Chen, Jiyan (författare)
Guangdong Gen Hosp, Guangzhou, Peoples R China.
Chernyavskiy, Alexander M. (författare)
Minist Hlth Russian Federat, E Meshalkin Natl Med Res Ctr E Meshalkin NMRC, Moscow, Russia.
Bhargava, Balram (författare)
All India Inst Med Sci, New Delhi, India.
Newman, Jonathan D. (författare)
NYU, Grossman Sch Med, New York, NY USA.
Hinic, Sasa B. (författare)
UHC Bezanijska Kosa, Belgrade, Serbia.
Jaroch, Joanna (författare)
Wroclaw Med Univ, T Marciniak Hosp, Wroclaw, Poland.
Hoye, Angela (författare)
Univ Hull, Castle Hill Hosp, Cottingham, England.
Berger, Jeffrey (författare)
NYU, Grossman Sch Med, New York, NY USA.
Boden, William E. (författare)
VA New England Healthcare Syst Boston, Boston, MA USA.
O'Brien, Sean M. (författare)
Duke Clin Res Inst, Durham, NC USA.
Maron, David J. (författare)
Stanford Univ, Dept Med, Stanford, CA 94305 USA.
Hochman, Judith S. (författare)
NYU, Grossman Sch Med, New York, NY USA.
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NYU, Grossman Sch Med, New York, NY USA Weill Cornell Med, New York, NY USA. (creator_code:org_t)
American Medical Association (AMA), 2020
2020
Engelska.
Ingår i: JAMA cardiology. - : American Medical Association (AMA). - 2380-6583 .- 2380-6591. ; 5:7, s. 773-786
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
Stäng  
  • Key PointsQuestion  When considering patients who have obstructive coronary artery disease and ischemia on stress testing, are there sex differences in severity of coronary artery disease, ischemia, and/or symptoms?Findings  In this secondary analysis of the ISCHEMIA randomized clinical trial of 5179 patients, women had more frequent angina, less extensive coronary artery disease, and less severe ischemia than men. On multivariate analysis, female sex was independently associated with greater angina frequency.Meaning  There may be inherent sex differences in the complex relationships between angina, ischemia, and atherosclerosis that may have implications for testing and treatment of patients with suspected coronary artery disease.AbstractImportance  While many features of stable ischemic heart disease vary by sex, differences in ischemia, coronary anatomy, and symptoms by sex have not been investigated among patients with moderate or severe ischemia. The enrolled ISCHEMIA trial cohort that underwent coronary computed tomographic angiography (CCTA) was required to have obstructive coronary artery disease (CAD) for randomization.Objective  To describe sex differences in stress testing, CCTA findings, and symptoms in ISCHEMIA trial participants.Design, Setting, and Participants  This secondary analysis of the multicenter ISCHEMIA randomized clinical trial analyzed baseline characteristics of patients with stable ischemic heart disease. Individuals were enrolled from July 2012 to January 2018 based on local reading of moderate or severe ischemia on a stress test, after which blinded CCTA was performed in most. Core laboratories reviewed stress tests and CCTAs. Participants with no obstructive CAD or with left main CAD of 50% or greater were excluded. Those who met eligibility criteria including CCTA (if performed) were randomized to a routine invasive or a conservative management strategy (N = 5179). Angina was assessed using the Seattle Angina Questionnaire. Analysis began October 1, 2018.Interventions  CCTA and angina assessment.Main Outcomes and Measures  Sex differences in stress test, CCTA findings, and symptom severity.Results  Of 8518 patients enrolled, 6256 (77%) were men. Women were more likely to have no obstructive CAD (<50% stenosis in all vessels on CCTA) (353 of 1022 [34.4%] vs 378 of 3353 [11.3%]). Of individuals who were randomized, women had more angina at baseline than men (median [interquartile range] Seattle Angina Questionnaire Angina Frequency score: 80 [70-100] vs 90 [70-100]). Women had less severe ischemia on stress imaging (383 of 919 [41.7%] vs 1361 of 2972 [45.9%] with severe ischemia; 386 of 919 [42.0%] vs 1215 of 2972 [40.9%] with moderate ischemia; and 150 of 919 [16.4%] vs 394 of 2972 [13.3%] with mild or no ischemia). Ischemia was similar by sex on exercise tolerance testing. Women had less extensive CAD on CCTA (205 of 568 women [36%] vs 1142 of 2418 men [47%] with 3-vessel disease; 184 of 568 women [32%] vs 754 of 2418 men [31%] with 2-vessel disease; and 178 of 568 women [31%] vs 519 of 2418 men [22%] with 1-vessel disease). Female sex was independently associated with greater angina frequency (odds ratio, 1.41; 95% CI, 1.13-1.76).Conclusions and Relevance  Women in the ISCHEMIA trial had more frequent angina, independent of less extensive CAD, and less severe ischemia than men. These findings reflect inherent sex differences in the complex relationships between angina, atherosclerosis, and ischemia that may have implications for testing and treatment of patients with suspected stable ischemic heart disease.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

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