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Effect of Sex Difference of Coronary Microvascular Dysfunction on Long-Term Outcomes in Deferred Lesions

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Author(s)
Ju-Hyun Chung Kyung Eun LeeJoo Myung Lee Ae-Young Her Chee Hae Kim Ki Hong Choi Young Bin Song Joo-Yong Hahn Hyung Yoon Kim Jin-Ho Choi Scot Garg Joon-Hyung Doh Chang-Wook Nam Bon-Kwon Koo Eun-Seok Shin
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
JACC: Cardiovascular interventions
Issued Date
2020
Volume
13
Issue
14
Keyword
coronary artery diseasecoronary flow reservefractional flow reserveindex of microcirculatory resistancemicrovascular function
Abstract
Objectives:
This study investigated the sex difference of long-term cardiovascular outcomes on coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients with deferred coronary artery lesions.

Background:
Coronary microvascular dysfunction is associated with poorer long-term outcomes. It can be assessed by CFR and the IMR.

Methods:
The study prospectively enrolled 434 patients (133 women and 301 men) and analyzed CFR, IMR, fractional flow reserve, and quantitative coronary angiography. Clinical outcomes were assessed by major adverse cardiovascular event(s) (MACE) of cardiac death, myocardial infarction, and revascularization during 5 years of follow-up. The study protocol was approved by the Institutional Review Board or Ethics Committee at each participating center, and all patients provided written informed consent. The study protocol was in accordance with the Declaration of Helsinki.

Results:
Women had milder epicardial disease compared with men (fractional flow reserve: 0.91 [interquartile range (IQR): 0.87 to 0.96] vs. 0.90 [IQR: 0.86 to 0.95]; p = 0.037). IMR was similar between the sexes, but CFR was lower in women (2.69 [IQR: 2.08 to 3.90] vs. 3.20 [IQR: 2.20 to 4.31]; p = 0.006) due to a shorter resting mean transit time, whereas hyperemic mean transit times were similar. At 5-year follow-up, MACE was significantly lower in women compared with men (1.1% vs. 5.5%; p = 0.017). Sex, diabetes mellitus, and CFR were independent predictors for MACE for all patients. The risk of MACE was significantly higher in men with low versus high CFR (hazard ratio: 4.58; 95% confidence interval: 1.85 to 11.30; p = 0.011) which was not seen in women.

Conclusions:
There was no sex difference in microvascular function by IMR. CFR was lower in women due to a higher resting coronary flow; however, long-term clinical outcomes in deferred lesions were better in women compared with men.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Citation
Ju-Hyun Chung et al. (2020). Effect of Sex Difference of Coronary Microvascular Dysfunction on Long-Term Outcomes in Deferred Lesions. JACC: Cardiovascular interventions, 13(14), 1669–1679. doi: 10.1016/j.jcin.2020.04.002
Type
Article
ISSN
1876-7605
Source
https://www.sciencedirect.com/science/article/pii/S1936879820308694
DOI
10.1016/j.jcin.2020.04.002
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43207
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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