Background

Coronary vasomotor dysfunction (defined by reduced myocardial blood flow reserve [MBFR]) is associated with high cardiac risk in both men and women in absence of significant coexisting epicardial disease. Whether there is a sex-specific difference in prognostic value of reduced MBFR in patients with a greater burden of coexisting epicardial atherosclerotic disease is not well understood.

Objectives

The purpose of this study was to examine the association of sex, MBFR, and mortality in consecutive patients with suspected or known coronary artery disease undergoing positron emission tomography myocardial perfusion imaging.

Methods

Unique consecutive patients undergoing rubidium (Rb)-82 rest/stress positron emission tomography myocardial perfusion imaging from 2010-2016 were followed for a median of 3.2 years. Multivariable Cox models were built to describe the interaction of sex and MBFR on all-cause and cardiac death for the overall population and stratified by extent of calcified atherosclerosis (none: coronary artery calcium score = 0, subclinical: coronary artery calcium >0, clinical: prior myocardial infarction/percutaneous coronary intervention) and abnormal perfusion (no significant obstructive disease: summed stress score = 0, 1%-9.9%, and ≥10%) at baseline.

Results

Among 12,594 patients, 52.8% were women. Compared with men, women had a lower prevalence of known coronary artery disease (16.5% vs 29.5%; P < 0.001) and were less likely to undergo revascularization after myocardial perfusion imaging (4.9% vs 9.7%; P < 0.001), but were more likely to have a reduced MBFR of <2 (56.2% vs 50.6%; P < 0.001). There were 1,699 (13.5%) all-cause and 490 (3.9%) cardiac deaths. In fully adjusted Cox models, reduced MBFR was independently associated with higher risk of death (HR per 0.1-U decrease: 1.09 [95% CI: 1.08-1.10]; P < 0.001), but female sex was not (HR: 0.95 [95% CI: 0.85-1.05]; P = 0.27). There was no significant interaction between sex and MBFR on death (P = 0.22) and cardiac death (P = 0.35) overall or in subgroups of patients with clinical, subclinical, and no atherosclerosis or across categories of perfusion abnormality at baseline.

Conclusions

The association between reduced MBFR and higher risk of all-cause and cardiac death did not differ by sex, regardless of extent of coexisting atherosclerosis or perfusion abnormality.

中文翻译：

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跨动脉粥样硬化疾病谱的性别、心肌流量储备减少和长期死亡率的关联

背景

冠状动脉血管舒缩功能障碍（定义为心肌血流储备减少 [MBFR]）与男性和女性的高心脏风险相关，而没有明显的并存心外膜疾病。对于合并心外膜动脉粥样硬化疾病负担较大的患者，MBFR 降低的预后价值是否存在性别特异性差异尚不清楚。

目标

本研究的目的是检查连续接受正电子发射断层扫描心肌灌注成像的疑似或已知冠状动脉疾病患者的性别、MBFR 和死亡率之间的关系。

方法

从 2010 年到 2016 年，接受铷 (Rb)-82 静息/应力正电子发射断层扫描心肌灌注成像的独特连续患者的中位随访时间为 3.2 年。建立多变量 Cox 模型来描述性别和 MBFR 对总体人群全因死亡和心源性死亡的相互作用，并按钙化动脉粥样硬化的程度进行分层（无：冠状动脉钙化评分 = 0，亚临床：冠状动脉钙化 > 0，临床: 既往心肌梗死/经皮冠状动脉介入治疗）和异常灌注（无明显阻塞性疾病：总压力评分 = 0、1%-9.9% 和 ≥10%）在基线时。

结果

在 12,594 名患者中，52.8% 为女性。与男性相比，女性已知冠状动脉疾病的患病率较低（16.5% vs 29.5%；P < 0.001），并且在心肌灌注成像后接受血运重建的可能性较小（4.9% vs 9.7%；P < 0.001），但更有可能将 MBFR 降低 <2（56.2% 对 50.6%；P < 0.001）。有 1,699 例（13.5%）全因死亡和 490 例（3.9%）心脏死亡。在完全调整的 Cox 模型中，MBFR 降低与更高的死亡风险独立相关（HR 每 0.1-U 降低：1.09 [95% CI：1.08-1.10]；P < 0.001），但女性则不是（HR：0.95 [ 95% CI：0.85-1.05]；P = 0.27)。性别和 MBFR 对死亡没有显着的交互作用（P =0.22) 和心源性死亡 ( P = 0.35) 总体或在基线时临床、亚临床和无动脉粥样硬化或跨类别灌注异常的患者亚组中。

结论

MBFR 降低与更高的全因死亡和心源性死亡风险之间的关联没有因性别而异，无论并存的动脉粥样硬化或灌注异常的程度如何。