Abstract 18129: Sex-Based Comparison of Angina Severity, Extent of Inducible Ischemia, and Burden of Angiographic Coronary Disease: A Post Hoc Analysis of the COURAGE Trial
Background: While sex-based differences in anginal symptoms are well-described, it is unclear whether similar differences exist in the extent of inducible ischemia and angiographic findings between men and women with stable ischemic heart disease. We examined the interrelationship of angina severity, objective measures of ischemia (by myocardial perfusion imaging [MPI]), and the burden of angiographic coronary artery disease (CAD) in both men and women participants in the COURAGE trial.
Methods: At baseline, 2,279 patients underwent coronary angiography and were divided into subgroups based on the number of diseased vessels and a myocardial jeopardy score to assess the extent/magnitude of inducible ischemia. Men and women were further stratified by Canadian Cardiology Society (CCS) angina class and were compared across measures of ischemia and anatomy. The 625 patients who underwent baseline stress MPI were also stratified by both angina severity and extent of angiographic CAD. Odds ratios for angina were calculated and compared by sex, after adjusting for potential confounders.
Results: In the unadjusted analysis, as compared with men, women had a similar overall prevalence of angina (86.4% vs. 87.8%, p = 0.47) and mean percent ischemic myocardium (7.9% vs. 7.7%, P = 0.84), but a lower prevalence of 3-vessel CAD (14.5% vs. 24.5%, P= 0.001) and mean jeopardy score (2.3% vs. 2.5%, P = 0.08), despite exhibiting a greater proportion of CCS II-III angina (64.5% vs. 56.5%, P = 0.006); see Figure 1. After multivariable adjustment, the significantly higher prevalence of CCS Class II-III angina in women persisted.
Conclusion: For any given severity of angiographic CAD or extent of myocardial ischemia, women had more moderate-severe (CCS Class II-III) angina than did men. However, this difference was more pronounced in subgroups of patients with more extensive angiographic CAD or severe ischemia by MPI, which likely reflects a greater atherosclerotic burden.
- © 2013 by American Heart Association, Inc.