妊娠期高血压疾病增加心肌梗死风险:一项基于人群的研究。

IF 21.7 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of the American College of Cardiology Pub Date : 2024-11-02 DOI:10.1016/j.jacc.2024.06.049
Lisa E Vaughan, Yoshihisa Kanaji, Sonja Suvakov, Santosh Parashuram, Yvonne S Butler Tobah, Alanna M Chamberlain, Suzette J Bielinski, Natasa Milic, Rajiv Gulati, Karl A Nath, Amir Lerman, Vesna D Garovic
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引用次数: 0

摘要

背景:关于有妊娠高血压疾病(HDP)病史的妇女的冠状动脉解剖结构和冠状动脉病变类型的血管造影证据很少:本研究旨在确定在接受冠状动脉造影术的妇女中,HDP 病史作为早期冠状动脉疾病(CAD)和急性冠状动脉综合征(ACS)类型(即动脉粥样硬化性冠状动脉病变与冠状动脉非阻塞性心肌梗死[MINOCA])的独特危险因素的作用:这项研究使用了一个基于人群的队列,其中包括接受冠状动脉造影术的偶发 CAD 女性患者和年龄匹配的对照受试者。SYNTAX(TAXUS[Boston Scientific]PCI[经皮冠状动脉介入治疗]与心脏手术之间的协同作用)评分用于确定CAD的复杂性和程度;MINOCA的诊断条件是在无阻塞性冠状动脉疾病的情况下出现临床急性心肌梗死:2002年11月7日至2016年12月31日期间,共有506名明尼苏达州奥姆斯特德县(Olmsted County)准女性居民发生了CAD和血管造影数据。与血压正常的女性相比,患有高密度脂蛋白血症的女性在发病时更年轻(中位数:64.8岁 vs 71.8岁;P = 0.030)。HDP 与 ACS 之间存在密切联系(未调整 P = 0.018)。与血压正常的孕妇相比,患有HDP的孕妇更有可能具有较高的SYNTAX评分(OR:2.28;95% CI:1.02-5.12;P = 0.046)和MINOCA评分(OR:2.08;95% CI:1.02-4.25;P = 0.044):结论:HDP 史与早年的 CAD 以及未来冠状动脉阻塞性和非阻塞性心肌梗死的风险有关。这项研究强调,除了传统的风险因素外,还需要及时发现和治疗非阻塞性疾病。
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Hypertensive Disorders of Pregnancy Increase the Risk for Myocardial Infarction: A Population-Based Study.

Background: Angiographic evidence of the anatomy of coronary arteries and the type of coronary artery lesions in women with a history of hypertensive disorders of pregnancy (HDP) are poorly documented.

Objectives: This study sought to determine the role of a history of HDP as a unique risk factor for early coronary artery disease (CAD) and type of acute coronary syndrome (ACS) (ie, atherosclerotic vs myocardial infarction with nonobstructive coronary arteries [MINOCA]) in women who underwent coronary angiography.

Methods: This study used a population-based cohort of parous female patients with incident CAD who underwent coronary angiography and age-matched control subjects. The SYNTAX (Synergy between PCI [percutaneous coronary intervention] with TAXUS [Boston Scientific] and Cardiac Surgery) score was assessed to determine the complexity and degree of CAD; MINOCA was diagnosed in the presence of clinical acute myocardial infarction in the absence of obstructive coronary disease.

Results: A total of 506 parous female Olmsted County, Minnesota (USA) residents had incident CAD and angiographic data from November 7, 2002 to December 31, 2016. Women with HDP were younger than normotensive women at the time of the event (median: 64.8 years vs 71.8 years; P = 0.030). There was a strong association between HDP and ACS (unadjusted P = 0.018). Women with HDP compared with women with normotensive pregnancies were more likely to have a higher SYNTAX score (OR: 2.28; 95% CI: 1.02-5.12; P = 0.046), and MINOCA (OR: 2.08; 95% CI: 1.02-4.25; P = 0.044).

Conclusions: A history of HDP is associated with CAD earlier in life and with a future risk for myocardial infarction with both obstructive and nonobstructive coronary arteries. This study underscores the need for timely detection and treatment of nonobstructive disease, in addition to traditional risk factors.

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来源期刊
CiteScore
42.70
自引率
3.30%
发文量
5097
审稿时长
2-4 weeks
期刊介绍: The Journal of the American College of Cardiology (JACC) publishes peer-reviewed articles highlighting all aspects of cardiovascular disease, including original clinical studies, experimental investigations with clear clinical relevance, state-of-the-art papers and viewpoints. Content Profile: -Original Investigations -JACC State-of-the-Art Reviews -JACC Review Topics of the Week -Guidelines & Clinical Documents -JACC Guideline Comparisons -JACC Scientific Expert Panels -Cardiovascular Medicine & Society -Editorial Comments (accompanying every Original Investigation) -Research Letters -Fellows-in-Training/Early Career Professional Pages -Editor’s Pages from the Editor-in-Chief or other invited thought leaders
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