Abstract 2868: Sex, Clinical Symptoms and Angiographic Findings at Baseline in BARI 2D
Background: Previous studies have reported differences in presenting symptoms and angiographic characteristics in women (W) and men (M) undergoing evaluation for suspected coronary artery disease (CAD). However, these finding may have been confounded by a higher prevalence of normal coronary arteries or insignificant CAD in W. Accordingly, we examined the relationship between presenting symptoms and extent of CAD in a high risk population with Type 2 diabetes (DM) and known CAD enrolled in the BARI 2D trial.
Results: Among 2321 patients enrolled, 686 (29.6%) were W and 1635 (70.4%) were M. Although mean age was similar in W and M, W had a higher prevalence of hypertension (87. 2% vs 80.4%, p < .0001) and longer duration of DM, (12.2 ± 9.6 vs 9.7 ± 8.1 years, p < .0001) but a lower prevalence of prior MI (27.9% vs 33.6%, p = .0074). W were more likely than M to have ischemic type chest pain in the preceding 6 weeks prior to enrollment (68.5% vs 60.8%, p = 0.0005). Among patients with stable angina, W had a higher CCS functional class compared with M, (CCS III or IV: 21.5% vs 14.6%, p = 0.003). W were also more likely than M to be taking long acting nitrates (36.1% vs 29.7%, p = 0.003). Fewer W than M had asymptomatic coronary artery disease (11.8% vs. 19.0%, p < 0.0001). Coronary angiography revealed a lower average number of significant lesions (≥50% stenosis) in W compared with M (2.3 vs 2.8, p < 0.0001), a lower prevalence of multiple diseased regions, (p < 0.0001) and a lower mean myocardial jeopardy score (41.0% ± 23.9% vs 45.9% ± 24.3% p < 0.0001). W were less likely than M to have significant (≥50%) proximal LAD involvement (11.4% v s 15.7%, p = 0.007) or chronic total occlusions (30.8% vs 45.2%, p < 0.0001).
Conclusions: Among a high risk group of patients with known CAD and DM, there were significant differences in presentation and coronary anatomy by sex. W were more symptomatic compared with M, yet had less extensive and significant coronary artery disease despite a longer duration of diabetes. These data suggest that factors other than epicardial coronary artery disease severity influence symptom presentation in W in this population.