부산대학교 도서관

Purpose: Important differences have been shown in various conditions regarding symptomatology and treatment between men and women. Little is known as to whether this also holds true for patients with 'unexplained' syncope. In this sub-analysis of the PICTURE international registry, we looked at such differences related to patientsʼ gender.Methods: In PICTURE, 570 patients with a Reveal (Medtronic Inc.) implantable loop recorder (ILR) were followed until the first recurrence of syncope or for at least 12 months after implant. Time to first syncope after implant was analyzed using a multivariate Cox regression.Results: The proportion of women was 53.7%, and they were older than men (60±17 vs. 62±18 years, p=0.03). Women more often had syncope associated with severe trauma (41% vs. 30%, p=0.01), and their position at the onset of syncope was different from men (p=0.01). In women, syncope occurred less often sitting (22% vs. 33%) and more often standing (53% vs. 42%). Women reported palpitations more often (17% vs. 10%, p=0.01), had significantly less events associated with muscle spasms/grand mal (2.3-4.9% vs. 0.3-2.6%) and saw a neurologist less often (43% vs. 53%, p=0.02) than men. There were no significant differences in comorbidity between women and men. Women underwent significantly fewer coronary angiograms (18% vs. 29%, p<0.01), exercise tests (47% vs. 58%, p=0.01), carotid sinus massage (32% vs. 41%, p=0.02) and MRI/CT scans (43% vs. 52%, p=0.04). The multivariate analysis showed a tendency of women to be at lower risk for syncope, although the association was not statistically significant (HR=0.75, 95% CI: 0.56-1.01). Once a diagnosis was obtained, there was no significant gender differences in the prescribed specific treatment, with the exception of drug therapy, which was more often administered in women (10% vs. 2%, p=0.03).Conclusions: There were important gender differences in symptomatology during events before ILR implant, which may have influenced the lower numbers of investigations for coronary artery disease, even if the underlying comorbidities were similar in women and men. Women seemed to be at lower risk for recurrence of syncope and they were treated more often with drug therapy.