RIGHETTI ANDREA FABIANA
Congresos y reuniones científicas
Título:
Contribution to the Clinical Recognition of Severe Coronary Disease in Women
Lugar:
Buenos Aires
Reunión:
Congreso; world Congress of Cardiology; 2008
Institución organizadora:
World Heart Federation, Argentine Society of Cardiology, Argentine Federation of Cardiology
Resumen:
Introduction: It is still a challenge to recognize the Severe Coronary Disease (SCD) in women.
Angor Pectoris (AP) which is a key player in the diagnosis in men, is only useful in women in a little more than 50% of the cases as it includes false positives, for instance X syndrome, and false negatives for example silent ischemia, atypical angor and/or equivalents such as dyspnea, arrhythmias, among others. Aims: Enhance the ability to predict SCD in women by analyzing in addition to the patients symptoms, the amount and type of traditional coronary heart disease risk factors (CHDRF). Methods and Materials: In three Argentinean cities, 319 coronary angiographies (CA) from women with presumably coronary artery disease (excluding acute coronary infarction and valvular disease) were individually analyzed by interventional and clinical cardiologists and divided into two groups: with severe lesions (SL) and with non-severe lesions [NSL (50% occlusion, including normal coronaries)]. According to the symptoms, the sample size was divided into three groups: Typical AP (TAP), Atypical AP (AAP) and other symptoms. With regards to CHDRF the sample was screened for age, Diabetes (DBT), Smoking (SM), Arterial Hypertension (HYP), Dyslipidemia (DLP) and Family History of cardiovascular diseases (FH). For each individual variable we determined: sensibility, specificity, predictive value, proof of efficacy, odds ratio and relative risk. We employed the chi-square method to evaluate the association among the risk factors and the SCD. A model was created through logistic regression analyses to identify the predictive risk factors of SCD. Results: Women
between 30 and 87, the average age was 63 11 years. We observed 62,1% had HYP; 22,6% DBT;47,3% DLP; 22,3% were smokers and 31,7% had FH. 54,9% of the cases showed TAP, 33,8% AAP and 11,3% other symptoms. With regards to the coronary angiograms: 48,6% showed NSL and 51,4% SL. The logistic model found the following results for each variable predictor: Age showed a lineal impact on the increased risk; HYP (OR: 2,68; IC 95%: 1,50?4,76); DBT (OR: 11,31; IC 95%: 5,11?25,04); DLP (OR: 4,86; IC 95%: 2,74?8,63), SM (OR: 4,63; IC 95%: 2,27?9,45), FH (OR: 2,60; IC 95%: 1,41? 4,84). Symptoms were not included as they are not good predictors. This model correctly classifies 75% of the patients with SL and 70% of the patients with NSL. Conclusion: The number and type of risk factor have a superior predictive value than the reason for consultation for recognizing SCD in women.
Our findings applied to clinical practice allow us to identify in a simple and in an inexpensive way the 75% of the patients at risk. This model could be considered in future research.
Angor Pectoris (AP) which is a key player in the diagnosis in men, is only useful in women in a little more than 50% of the cases as it includes false positives, for instance X syndrome, and false negatives for example silent ischemia, atypical angor and/or equivalents such as dyspnea, arrhythmias, among others. Aims: Enhance the ability to predict SCD in women by analyzing in addition to the patients symptoms, the amount and type of traditional coronary heart disease risk factors (CHDRF). Methods and Materials: In three Argentinean cities, 319 coronary angiographies (CA) from women with presumably coronary artery disease (excluding acute coronary infarction and valvular disease) were individually analyzed by interventional and clinical cardiologists and divided into two groups: with severe lesions (SL) and with non-severe lesions [NSL (50% occlusion, including normal coronaries)]. According to the symptoms, the sample size was divided into three groups: Typical AP (TAP), Atypical AP (AAP) and other symptoms. With regards to CHDRF the sample was screened for age, Diabetes (DBT), Smoking (SM), Arterial Hypertension (HYP), Dyslipidemia (DLP) and Family History of cardiovascular diseases (FH). For each individual variable we determined: sensibility, specificity, predictive value, proof of efficacy, odds ratio and relative risk. We employed the chi-square method to evaluate the association among the risk factors and the SCD. A model was created through logistic regression analyses to identify the predictive risk factors of SCD. Results: Women
between 30 and 87, the average age was 63 11 years. We observed 62,1% had HYP; 22,6% DBT;47,3% DLP; 22,3% were smokers and 31,7% had FH. 54,9% of the cases showed TAP, 33,8% AAP and 11,3% other symptoms. With regards to the coronary angiograms: 48,6% showed NSL and 51,4% SL. The logistic model found the following results for each variable predictor: Age showed a lineal impact on the increased risk; HYP (OR: 2,68; IC 95%: 1,50?4,76); DBT (OR: 11,31; IC 95%: 5,11?25,04); DLP (OR: 4,86; IC 95%: 2,74?8,63), SM (OR: 4,63; IC 95%: 2,27?9,45), FH (OR: 2,60; IC 95%: 1,41? 4,84). Symptoms were not included as they are not good predictors. This model correctly classifies 75% of the patients with SL and 70% of the patients with NSL. Conclusion: The number and type of risk factor have a superior predictive value than the reason for consultation for recognizing SCD in women.
Our findings applied to clinical practice allow us to identify in a simple and in an inexpensive way the 75% of the patients at risk. This model could be considered in future research.
