BACKGROUND Coronary vasomotor dysfunction is an important mechanism for angina in patients with unobstructed coronary arteries. OBJECTIVES The purpose of this study was to determine sex differences in the prevalence and clinical presentation of vasomotor dysfunction in a European population and to examine sex differences in the dose of acetylcholine leading to a positive acetylcholine provocation test (ACH test). METHODS Between 2007 and 2014, we included 1,379 consecutive patients with stable angina, unobstructed coronaries and ACH test performed for epicardial vasospasm or coronary microvascular dysfunction (CMD) due to microvascular spasm. The predictive value of sex, risk factors, symptoms, and noninvasive test results was analyzed by means of logistic regression. RESULTS The mean patient age was 62 years, and 42% were male. There were 813 patients (59%) with a pathological ACH test, 33% for CMD and 26% for epicardial vasospasm. A pathological test was more common in females (70% vs. 43%; p < 0.001). In a multivariable logistic regression model the sex difference was statistically significant with a female-male odds ratio for CMD and epicardial vasospasm of 4.2 (95% confidence interval: 3.1 to 5.5; p < 0.001) and 2.3 (95% confidence interval: 1.7 to 3.1; p < 0.001), respectively. Effort-related symptoms, but neither risk factors nor noninvasive stress tests, contributed to predicting a pathological test. Female patients were more sensitive to acetylcholine with vasomotor dysfunction occurring at lower ACH doses compared with male patients. CONCLUSIONS Vasomotor dysfunction is frequent in patients with angina and unobstructed coronaries in a European population. Female patients have a higher prevalence of vasomotor dysfunction (especially CMD) compared with male patients. A pathological ACH test was observed at lower ACH doses in women compared with men.

中文翻译：

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心绞痛和冠状动脉通畅患者血管舒缩功能的性别差异

背景冠状动脉舒缩功能障碍是冠状动脉通畅患者心绞痛的重要机制。目的 本研究的目的是确定欧洲人群血管舒缩功能障碍患病率和临床表现的性别差异，并检查导致乙酰胆碱激发试验（ACH 试验）阳性的乙酰胆碱剂量的性别差异。方法 2007 年至 2014 年间，我们纳入了 1,379 名患有稳定型心绞痛、冠状动脉通畅和因微血管痉挛导致的心外膜血管痉挛或冠状动脉微血管功能障碍 (CMD) 的 ACH 测试的连续患者。采用Logistic回归分析性别、危险因素、症状、无创检测结果的预测价值。结果 患者的平均年龄为 62 岁，42% 为男性。有 813 名患者 (59%) 进行了病理 ACH 测试，33% 为 CMD，26% 为心外膜血管痉挛。病理检查在女性中更为常见（70% 对 43%；p < 0.001）。在多变量逻辑回归模型中，性别差异具有统计学意义，CMD 和心外膜血管痉挛的女性-男性优势比为 4.2（95% 置信区间：3.1 至 5.5；p < 0.001）和 2.3（95% 置信区间：1.7 至3.1；p < 0.001)，分别。与努力相关的症状，但无论是危险因素还是非侵入性压力测试，都有助于预测病理测试。与男性患者相比，女性患者对乙酰胆碱更敏感，在较低的 ACH 剂量下发生血管舒缩功能障碍。结论 在欧洲人群中，心绞痛和冠状动脉通畅患者经常出现血管舒缩功能障碍。与男性患者相比，女性患者血管舒缩功能障碍（尤其是 CMD）的患病率更高。与男性相比，女性在较低的 ACH 剂量下观察到病理 ACH 测试。