2016


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2016/№2

Incidence of intact coronary arteries and factors associated with non-obstructive ischemic heart disease in men and women

Korok E. V., Sumin A. N., Barbarash L. S.
Federal State Budgetary Institution, “Research Institute for Complex Issues of Cardiovascular Diseases” at the Siberian Branch of the Russian Academy of Medical Sciences, Sosnovy Bulvar 6

Keywords: IHD, ACS, coronary angiography, gender peculiarities, diagnosis

DOI: 10.18087/rhj.2016.2.2166

Background. In the recent years, more and more data have become available that CVDs are the major cause of death in women. There is a problem of “unjustified” invasive coronary angiography (CAG), which rather often detects non-obstructive IHD. However, gender-related features of predictors for non-obstructive IHD are presently understudied. Aim. To study incidence of intact CA and factors associated with non-obstructive IHD in men and women. Materials and methods. A retrospective analysis included 457 medical records of patients who had had elective CAG. Four groups were formed: group 1, women with suspected IHD (n=118); group 2, women with a history of MI (n=52), group 3, men with suspected IHD (n=130); and group 4, men with a history of MI (n=157). Results. Women were older than men, had higher BWI (р<0.001), and had higher incidence of AH (p<0.001). Men with a history of MI less frequently displayed a clinical picture of angina (р<0.001). CHF was primarily observed in patients with either sex with a history of MI (р=0.006). Furthermore, men with a history of MI had the lowest LV EF (р=0.030). According to CAG data the absence of occluding angina changes in coronary arteries was most prevalent in women with suspected IHD (54,2 %) and least prevalent in men with a history of MI 9.6 % (р<0.001). Mild coronary lesions (stenosis <60 %) prevailed in women and men with suspected IHD (17 % and 17.7 %) compared to patients with a history of MI (5.8 and 8.9 %, p=0.032). Incidence of significant CA lesions (stenosis ≥70 %) was significantly higher for women and men with a history of MI (69.2 and 79 %, p<0.001). Incidence of a typical picture of angina was similar for all evaluated patients (р=0.725) while an atypical picture prevailed in men with suspected IHD (16.2 %), and only female and male patients with suspected IHD has false angina pain, 9.3 and 3.6 % (р=0.002 and р<0.001). Pretest probability (PTP) of coronary lesions was significantly higher in men with a history of MI (77 %) or suspected IHD (77 %) as compared with women, 58 % (р<0.001). According to data of multifactorial analysis false angina pain was an independent predictor of intact CA in women while older age (р<0.001), and a history of MI (р=0.004) or DM (р=0.041), in contrast, increased the risk for atherosclerotic lesion in coronary vasculature. A multifactorial analysis showed an independent effect of increased LV EF on the absence of occluding stenotic CA lesions. At the same time, presence of DM, typical clinical picture of angina, and a history of MI (р<0.05) reduced the probability of intact CA. Conclusion. Elective CAG detected intact CA in 44.7 % of women and 19.8 % of men. Among them, 37,6% of women and 14.6 % of men had suspected IHD. The probability of detecting intact CA was associated with presence of false angina pain in women and with increased LV EF in men. Furthermore, older age in women, a typical clinical picture of angina in men, and a history of DM or MI in both men and women were independent predictors for atherosclerotic lesions of coronary vasculature.
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Korok E. V., Sumin A. N., Barbarash L. S. Incidence of intact coronary arteries and factors associated with non-obstructive ischemic heart disease in men and women. Russian Heart Journal. 2016;15 (2):93–103

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