Abstract 18397: Higher Rates of Normal Coronaries and Nonobstructive CAD in Women Across Referral Indications Despite Similar Comorbidities
Introduction: A high rate of normal coronary arteries in patients referred for invasive coronary angiography (ICA) has been reported previously. We sought to evaluate gender differences in clinical characteristics, referral indications, stenosis severity, and appropriateness in consecutive patients referred for index ICA for ischemia evaluation.
Methods: We retrospectively analyzed data on 925 patients who underwent non-emergent index ICA. Stenosis severity was defined as normal (≤20%), nonobstructive (21-49%), and obstructive (≥50%). Clinical data was abstracted from the medical record and compared by gender using chi-square analysis and logistic regression.
Results: The study cohort was 44.4% women. Stenosis severity varied significantly by gender (p<0.001). Women had more normal coronaries (37.7% vs. 25.7%) and less obstructive CAD (46.5% vs. 62.7%). Women had lower rates of obstructive CAD across all referral indications as shown in the Figure. This pattern persisted in the stress imaging subgroup despite similar rates of ischemia in women and men without obstructive CAD (83.8% vs.76.8%, p=0.32). Likewise, women with NSTEMI had a lower rate of obstructive CAD despite a higher median troponin level in this subgroup (0.9 vs. 0.4, p=0.010). In patients referred for chest pain syndromes, fewer women had elevated ASCVD risk (67.7% vs 82.8%, p=0.017). Of those women at elevated risk, 58.7% had no obstructive CAD. The appropriateness of ICA was very high in both women (98.8%) and men (99.6%).
Conclusions: The lower rate of obstructive CAD in women persists despite appropriate tests, high ASCVD risk, and similar rates of ischemia and higher troponin levels in those without obstructive CAD. Possible mechanisms for stress ischemia, NSTEMI, and chest pain in patients without obstructive CAD include microvascular and endothelial dysfunction.
Author Disclosures: M.L. Ouellette: None. A.I. Loffler: None. V.K. Workman: None. G.A. Beller: None. J.M. Bourque: Research Grant; Modest; Astellas Pharma.
- © 2016 by American Heart Association, Inc.