Abstract 19278: Sex Differences in Management and Outcomes of Patients With Stable Symptoms Suggestive of Coronary Artery Disease: Insights From the PROMISE Trial
Background: Although sex differences exist in the management of acute coronary syndromes, less is known about the management and outcomes of women and men with suspected coronary artery disease (CAD) subsequent to non-invasive testing (NIT).
Methods: Among 8966 patients (4720 women, 4246 men) randomized to CT angiography vs stress testing in the PROMISE trial, sequential logistic regression models assessed relationships between sex and referral for catheterization (cath), revascularization (revasc), and aspirin/statin use. Cox regression models assessed the relationship between sex and all-cause death, myocardial infarction, or unstable angina.
Results: Women were less likely to be referred for cath than men, both before and after adjustment for baseline characteristics, NIT modality, and NIT results (8% vs 13%, adjusted OR 0.72 [0.60-0.87]; p<0.001). Of those who underwent cath (358 women, 534 men), fewer women than men underwent revasc (35% vs 54%), but after adjustment for cath results plus the above factors, this was not significant (adj OR 0.72 [0.44-1.17]; p=0.19). Among women and men with an indication for aspirin or statin, there were no significant differences in use at 60 days (aspirin adj OR 1.05 [0.47-2.37]; statin adj OR 1.76 [0.71-4.47]; both p=NS). Despite a lower cath rate after taking NIT results into account, and similar revasc rate after taking cath results into account, women had outcomes that were better or not significantly different from men over a median follow-up of 25 months (Figure).
Conclusions: Among patients with stable symptoms suggestive of coronary ischemia who undergo NIT, women are less likely to be referred for cath, although revasc and medical treatment rates are not significantly different. Thus, sex differences exist in the management of patients with suspected CAD, but they seem to dissipate when CAD is documented angiographically. Outcomes of women with stable symptoms suggestive of CAD are better overall than those of men.
Author Disclosures: N. Pagidipati: Ownership Interest; Modest; Freedom Health, Physician Partners, RXAdvance, Florida Medical Associates. A. Coles: None. K. Hemal: None. K.L. Lee: None. R.J. Dolor: None. P.A. Pellikka: None. D.B. Mark: Research Grant; Significant; Eli Lilly, Bristol-Myers Squibb, Gilead Sciences, AGA Medical, Merck, Oxygen Biotherapeutics, AstraZeneca. Consultant/Advisory Board; Modest; Medtronic, CardioDx, St. Jude Medical. M.R. Patel: Research Grant; Significant; AstraZeneca, CSL, HeartFlow, Janssen Research & Development, Maquet, Medtronic, NHLBI. Consultant/Advisory Board; Modest; AstraZeneca, Bayer, CSL, Genzyme, Janssen Research & Development, Medtronic, Merck & Co. S.E. Litwin: None. M.A. Daubert: None. S.H. Shah: None. U. Hoffmann: Research Grant; Significant; HeartFlow, Siemens Healthcare. P.S. Douglas: Research Grant; Significant; General Electric, HeartFlow.
- © 2016 by American Heart Association, Inc.