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Published on: August 28, 2018
Coronary arteriographic findings in 1,000 women under age 50
Insights
Significant coronary artery disease affects nearly a quarter of women under 50 experiencing chest pain. High cholesterol is linked to increased disease prevalence, underscoring the need for early diagnosis.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) is increasingly recognized in younger women.
- Chest pain evaluation in women under 50 often involves complex differential diagnoses.
- Coronary cinearteriography is a key diagnostic tool for assessing significant coronary artery narrowing.
Purpose of the Study:
- To evaluate the prevalence and characteristics of coronary artery disease in women under 50 presenting with chest pain.
- To correlate clinical symptoms and risk factors with arteriographic findings.
- To assess the diagnostic accuracy of clinical assessment for angina pectoris in this demographic.
Main Methods:
- Coronary cinearteriography was performed on 1,000 women under 50 years old presenting with chest pain.
- Patients were assessed for the degree of coronary artery narrowing.
- Serum cholesterol levels and electrocardiographic findings were analyzed in relation to arteriographic results.
Main Results:
- 23.6% of women studied had at least 50% narrowing of one or more coronary arteries.
- Significant CAD prevalence increased with higher serum cholesterol levels (10% <200 mg/100 ml vs. 44% >275 mg/100 ml).
- Clinical diagnosis of angina pectoris showed only 50% correlation with significant CAD, suggesting frequent misdiagnosis.
Conclusions:
- Coronary artery disease is prevalent in women under 50 with chest pain, with risk factors like elevated cholesterol playing a significant role.
- Coronary arteriography is crucial for accurate diagnosis of CAD in women under 50 presenting with angina-like symptoms.
- The frequent discrepancy between clinical suspicion of angina and arteriographic findings highlights the need for objective diagnostic methods.
Abstract:
In a consecutive series of 1,000 women under age 50 examined by coronary cinearteriography principally for evaluation of chest pain, 236 had at least 50 percent narrowing of one or more coronary arteries. The youngest, and the only patient who died, was 26 years old. The anterior descending coronary artery was the vessel most frequently involved; the right coronary artery was most often totally occluded. The amount of arterial involvement seemed to be related to the duration of symptoms. Only 10 percent of women with serum cholesterol levels under 200 mg/100 ml had significant coronary artery disease, whereas 44 percent of those with levels over 275 mg/100 ml had significant disease. Electrocardiographic evidence of myocardial infarction was uncommon in women with single vessel disease, but left ventriculograms disclosed that additional patients had areas of decreased contractility. Eleven of 46 women with electrocardiographically diagnosed myocardial infarction had no significant coronary artery disease. The cause of the electrocardiographic finding remained obscure in some. Although there was an excellent correlation of clinical diagnoses with arteriographic findings in women thought not to have angina pectoris, only half of those thought to have angina pectoris had significant coronary artery disease. This finding may be a major reason for recommending coronary arteriography for the evaluation of angina-like pain in women under age 50.
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