Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
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1683-1764
1735-7322
10.18869/acadpub.tumj
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jalali
1390
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gregorian
2011
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مقایسه پیامدهای بالینی زنان و مردان با سندرم کرونری حاد و آنژیوگرافی منفی: یک مطالعه کوهورت آیندهنگر
The clinical outcome of patients with acute coronary syndrome without critical stenosis in angiography: a prospective cohort study
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<p style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span style="font-size: 10pt">زمینه و هدف</span></strong><span style="font-size: 10pt">:</span><span style="font-size: 10pt"> </span><span style="font-size: 10pt">تاکنون بیماران علامتدار
با آنژیوگرافی منفی را دارای پیشآگهی خوب میدانستند اما شواهد اخیر پیشنهاد میدهند
که پیآمدهای بالینی این بیماران شایعتر از میزانهای مورد انتظار و دارای تفاوتهای
قابل توجهی در دو جنس است. هدف این پژوهش مقایسه عوامل موثر در وقوع پیامدهای
قلبی- عروقی زنان و مردان با تشخیص سندرم کرونری حاد و نتیجه آنژیوگرافی منفی است.</span><em><span style="font-size: 10pt"> <br></span></em></p><p style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><em><span style="font-size: 10pt"></span></em><strong><span style="font-size: 10pt">روش بررسی:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">در یک مطالعه کوهورت
191 زن با سندرم کرونر حاد و آنژیوگرافی منفی و 146 مرد با آنژیوگرافی منفی مقایسه
شدند. پس از یکسال پیگیری پیآمدهای بالینی آنها بررسی شد.</span><strong><em><span style="font-size: 10pt"> <br></span></em></strong></p><p style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><em><span style="font-size: 10pt"></span></em></strong><strong><span style="font-size: 10pt">یافتهها:</span></strong><span style="font-size: 10pt"> </span><span style="font-size: 10pt">پیامدهای بالینی یک
سال بعد در زنان و مردان تفاوت معنیداری داشت. در زنان سکته قلبی با بالا رفتن
قطعه </span><span style="font-size: 7pt">ST</span><span style="font-size: 10pt"> <span lang="AR-SA">(6/1%</span></span><span style="font-size: 10pt">)</span><span style="font-size: 10pt">3</span><span style="font-size: 7pt"> </span><span style="font-size: 10pt">آنژین صدری ناپایدار (5/11%)22
و سکته قلبی با موج </span><span style="font-size: 7pt">Q</span><span style="font-size: 10pt"> <span lang="AR-SA">(5/0%)1 و هیچ موردی از سنکوپ مشاهده نگردید. در
مردان (7/2%)4 سکته قلبی با بالا رفتن قطعه </span></span><span style="font-size: 7pt">ST</span><span style="font-size: 10pt">- آنژین صدری ناپایدار در (9/19%)29 موارد، (7/0%)1
سکته قلبی با موج </span><span style="font-size: 7pt">Q</span><span style="font-size: 10pt"> و (7/0%)1 سنکوپ مشاهده گردید. در زنان: عدم فعالیت فیزیکی (035/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">)، دیس لیپیدمی
با (001/0=</span><span style="font-size: 7pt">P</span><span style="font-size: 10pt">) شاخص مچ پایی بازویی پایین با (024/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">) و سن 50-40 سال (004/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">) با پیامدهای
بالینی دارای ارتباط معنیدار آماری بودند و در مردان، شاخص توده بدنی 99/39-30، با
(011/0</span><span style="font-size: 7pt">=</span><span style="font-size: 7pt">P</span><span style="font-size: 10pt">) با بروز
بالاتری از پیآمدهای بالینی پس از یک سال همراه بود.</span></p><p style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><span style="font-size: 10pt"> </span><strong><span style="font-size: 10pt">نتیجهگیری:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">پیآمدها
در زنان و مردان به طور معنیداری متفاوت است. این تفاوتها بر اساس فاکتورهای خطر
مختلف همچنان معنیدار است. استمرار علایم نشاندهنده توسعه بیماری عروق کرونر علیرغم
نتایج منفی آنژیوگرافی است.</span><strong><em><span style="font-size: 10pt"> </span></em></strong><strong><em></em></strong></p>
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<!--stripped--> <strong>Background</strong><strong>:</strong> Previous studies were suggestive of a good prognosis in patients
with acute coronary syndrome (ACS) and absence of any critical stenosis in coronary angiography but recent
limited reports have revealed that patients with non-obstructive acute coronary
syndrome are at a higher risk of future clinical coronary events. <br><strong></strong></p>
<p style="text-align: justify"><strong>Methods</strong> <strong>:</strong> A concurrent prospective cohort study was designed and 146 male patients with ACS and non-obstructive coronary
artery disease were regarded as the unexposed group, while 191 female patients with non-obstructive
coronary artery disease were regarded as the exposed group. Coronary events were
recorded within one year of follow-up. Prognostic factors were evaluated at
baseline by using a standardized protocol. <br><strong>Results</strong> <strong>:</strong> Of the 337 patients with ACS, 191 (56.6%) were female. Coronary events in female patients after one year of
follow-up were: ST EMI 3 (1.6%), unstable angina pectoris 22 (11.5%),
Q-wave MI
1 (0.5%) and no syncope. In male patients the outcomes
were: ST EMI 4 (2.7%), unstable angina pectoris 29 (19.9%),
Q-wave MI 1
(0.7%), and syncope 1 (0.7%). Multivariate adjusted
relationships revealed that physical inactivity (P=0.035),
dyslipidemia (P=0.001), low ankle brachial
index (P=0.024) and
age between 40-50 years (P=0.004) were significantly associated with coronary events in women. In
male patients, body mass index of 30-39.99
(P=0.011) was associated with a higher
rate of ST-segment elevated MI.<br><strong>Conclusion:</strong> Prognostically,
coronary events and clinical endpoints were significantly different between men
and women with acute coronary syndrome. Persistence of symptoms over one year seems
to relate to the development and progression of coronary atherosclerosis.</p>
بیماری عروق کرونر،آنژیوگرافی،فاکتور خطر،پیشآگهی،سکته قلبی،آنژین صدری
Angiography,angina pectoris,coronary artery disease,myocardial infarction,prognosis,risk factor
460
466
http://tumj.tums.ac.ir/browse.php?a_code=A-10-25-201&slc_lang=fa&sid=1
Nadia Hatmi
Z
زینت
نادیا حتمی