Abstract 18628: Atypical Symptoms and Results of Non-Invasive Tests Do Not Explain Poor Diagnostic Yield of Invasive Angiography in Women Suspected of Obstructive Coronary Artery Disease
Background: Angina pectoris is the most common symptom of coronary artery disease (CAD) among women but large studies have indicated low diagnostic yield of invasive coronary angiography (ICA). It is well accepted that women have more atypical symptoms and that some tests perform less well in women.
Purpose: To examine whether symptoms and non-invasive test result (NIT) are less predictive of obstructive CAD in women compared to men in a large city hospital.
Methods: Patients referred for assessment of stable CAD in 2012-2014 in a single center were included. Information on symptoms, risk factors, results of NIT and ICA was gathered from registries and patient records. Ability of symptoms and NIT result to predict obstructive CAD in men and women was compared in multiple adjusted logistic regression models by testing for statistical interaction.
Results: A total of 2763 patients were included, 1462 (53%) women. Women were older (59.1 vs 56.4 years, p<0.0001), more likely to have non-anginal chest pain and less likely to have typical and atypical angina. Overall, 89% were assessed with NIT. Women were less likely to have a positive NIT (37 versus 63%, p<0.001) and less likely to be referred to ICA (19% versus 26%, p<0.001). However, after adjusting for age, symptoms and results of NIT, referral to ICA did not differ by gender. Overall, 3% of women and 10% of men were diagnosed with obstructive CAD (p<0.001). In both men and women, typical angina symptoms and positive NIT were highly predictive of obstructive CAD (Table) but with no gender difference in the predictive value. Men had an OR 3.3 (95% C.I. 2.2-5.0) of having obstructive CAD compared to women.
Conclusions: The study confirmed that in contemporary clinical practice a very low proportion of patients suspected of CAD have significant coronary artery obstructions. Women have less typical symptoms and are less likely to have positive NIT, but the predictive value of both symptoms and NIT is similar in women and men.
Author Disclosures: C.B. Therming: None. S. Galatius: None. M. Heitmann: None. H. Dominguez: None. D. Husum: None. J. Bech: None. T. Hermann: None. T. Sehestedt: None. S. Højberg: None. C. Sørum: None. J. Reeh: None. L. Rørdam: None. E. Prescott: None.
- © 2016 by American Heart Association, Inc.