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[Differences in the clinical performance and initial diagnosis in women with suspected coronary artery disease]
C M Schannwell1, F C Schoebel, D Lazica
1Klinik für Kardiologie, Pneumologie und Angiologie, Heinrich-Heine-Universität Düsseldorf. schannw@uni-duesseldorf.de
Insights
Coronary heart disease (CHD) diagnosis is less reliable in women due to less predictive clinical symptoms and exercise ECG tests. Women require more sensitive diagnostic methods for accurate initial CHD detection.
Area of Science:
- Cardiology
- Diagnostic Medicine
Context:
- Coronary heart disease (CHD) is a leading cause of mortality, yet often underestimated in women.
- Initial diagnosis of CHD in women presents unique challenges compared to men.
Purpose:
- To investigate specific symptom presentations and diagnostic features of CHD in women.
- To compare the diagnostic reliability of clinical symptoms and exercise ECG in women versus men.
Summary:
- Women experienced longer delays in CHD diagnosis (68 months vs. 9 months for men) and had less predictive clinical symptoms (33% vs. 85% for men).
- Exercise ECG tests were less reliable in women, with lower positive predictive values for CHD.
- Despite comparable risk factors, women showed atypical symptom patterns and lower diagnostic accuracy with standard methods.
Impact:
- Highlights the need for more sensitive diagnostic tools beyond exercise ECG for women with suspected CHD.
- Emphasizes the underestimation of CHD in women and the critical importance of timely and accurate diagnosis.
- Findings can inform clinical practice guidelines for improved CHD detection in female patients.
Background And Objective:
Although coronary heart disease (CHD) is a major cause of morbidity and mortality, it is still being underestimated in women. This prospective study was undertaken to ascertain special features of the symptoms and in the initial diagnosis of CHD in women.
Patients And Methods:
Between January 1996 and August 1998, a total of 5000 patients (2500 women, 2500 men; mean age 61 [39-83]) were admitted for their initial invasive investigation of suspected CHD. All data relating to history, laboratory tests, resting and exercise ECG, and coronary angiography were recorded and analysed.
Results:
Typical angina pectoris as initial symptom was recorded in 40% of women, 57% of men, atypical symptoms in 48% vs. 24%. Typical angina pectoris in the presence of demonstrated CHD were found in 32% of women, compared with 69% in men. The interval from initial symptoms to established diagnosis was 68 months in women and 9 months in men, 71% of women but only 5% of men having consulted at least two specialists. Both women and men with CHD had comparable risk factors. Anginal symptoms prematurely ended an exercise ECG test in 49% of women and 44% of men. Significant S-T segment changes were noted in 19% of women, 30% of men with CHD. The positive predictive value of clinical symptoms and ergometric results with regard to CHD was much lower in women than in men: 33% vs 85%.
Conclusions:
Clinical symptoms and the exercise ECG are much less diagnostically reliable in women than in men and had a very low predictive value. Women often have typical anginal symptoms even in the absence of CHD. They, therefore, require more sensitive methods than the exercise ECG for the initial diagnosis of CHD, especially in the face of prolonged symptom-to-diagnosis intervals.