女性的风险出现于冠状动脉斑块负担较低的男性:PROMISE试验
Jan M Brendel1, Thomas Mayrhofer2, Júlia Karády1,3,4
1Department of Radiology, Cardiovascular Imaging Research Center (CIRC) (J.M.B., J.K., N.M.K., I.L.L., M.J., M.C.L., M.T.L., B.F.), Massachusetts General Hospital, Harvard Medical School, Boston.
Circulation. Cardiovascular imaging
|February 23, 2026
概括
心血管风险与冠状动脉斑在女性比男性增加得更快. 这些发现凸显了对冠状动脉计算机断层扫描血管造影斑块指标的性别特定解释的需要,以便在妇女中及时进行干预.
科学领域:
- 心脏病学 心脏病学
- 医疗成像医学成像
- 血管生物学 血管生物学
背景情况:
- 定量冠状动脉斑块测量在女性和男性的预后价值有所不同.
- 目前尚不完全清楚,心血管风险是否与男性和女性的斑块程度成比例.
- 这项研究调查了在男性和女性呈现稳定胸痛的冠状动脉斑块量的量化测量中心血管风险轨迹.
研究的目的:
- 为了比较心血管风险轨迹跨定量冠状动脉斑块测量在妇女和男性稳定的胸痛.
- 为了确定心血管风险是否与两性斑块扩张成比例增加.
- 评估冠状动脉斑块指标的预后值的性别特异性差异.
主要方法:
- 来自PROMISE (评估胸痛的前性多中心成像研究) 冠状动脉计算机断层扫描血管学队列的数据分析.
- 总冠状动脉斑块体积和斑块负荷 (PB) 的量化,包括化,非化和低衰减成分.
- 使用性别分层的Spline-Cox模型来评估斑块测量与主要心血管不良事件 (MACE) 在26个月的中位数之间的关联.
主要成果:
- 在4267名患者 (2199名女性) 中,女性的斑块发病率较低 (55%对75%),总斑块体积较低,但总斑块负担和MACE率相似.
- 与男性相比,女性的斑块负担较低时出现主要不良心血管事件风险.
- 随着女性的斑块负担增加,MACE的危险比率比男性增加得更快,特别是在非化斑块负担方面.
结论:
- 主要的不良心血管事件似乎出现在较低的斑块负担下,在女性中增加得更快.
- 这些发现支持对冠状动脉计算机断层扫描血管学衍生的斑块指标的性别特定解释的需要.
- 这种方法可以为心血管风险较高的妇女提供及时和定制的干预措施.
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