Female sex: a protective role in suspected myocardial ischemia
Charles A Henrikson1, Eric E Howell, David E Bush
1Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA. chenriks@jhmi.edu
Insights
Women presenting with chest pain undergo less cardiac testing and have better outcomes than men. This study suggests a potential protective effect in women, challenging assumptions about coronary artery disease in this population.
Area of Science:
- Cardiology
- Sex Differences in Medicine
- Clinical Outcomes
Background:
- Existing data on coronary artery disease (CAD) outcomes in women are often based on acute coronary syndrome trials.
- There's a need to investigate sex-based differences in the evaluation and prognosis of chest pain in the general patient population.
Purpose of the Study:
- To investigate sex differences in the workup and outcomes of patients presenting with chest pain.
- To determine if women with chest pain have different diagnostic testing rates and subsequent health events compared to men.
Main Methods:
- A cohort of 439 consecutive patients admitted with ongoing chest pain was examined.
- Cardiac testing included cardiac catheterization or stress tests; positive tests indicated significant coronary artery stenosis or abnormal stress results.
- Follow-up was conducted at 4 months post-discharge via telephone.
Main Results:
- Women were less likely to receive further cardiac testing (68%) compared to men (77%).
- Among those tested, women had significantly lower rates of positive test results (21%) than men (41%).
- At 4 months, women experienced fewer adverse events (myocardial infarction, revascularization, death) than men (15% vs. 23%).
Conclusions:
- Women admitted with chest pain appear less likely to have active coronary artery disease.
- Women demonstrate a significantly lower likelihood of poor outcomes at 4 months compared to men.
- The observed 'gender protection' in outcomes warrants further investigation.
Objective:
Women are felt to have poor outcomes in coronary artery disease, largely on the basis of secondary observations in acute coronary syndrome trials. We sought to examine the neglected topic of sex differences in workup and outcomes in the general population presenting with chest pain.
Methods:
We examined 439 consecutive patients admitted via the emergency department with ongoing chest pain. Cardiac testing was defined as any cardiac catheterization or stress test. Positive testing was defined as a 70% or greater stenosis in an epicardial coronary artery on catheterization, or a positive stress test result. Follow-up was obtained via telephone contact at 4 months following discharge.
Results:
Further cardiac testing was deemed necessary in 68% (164/241) of women and 77% (153/198) of men (P=0.038). Among women undergoing further testing, only 21% (35/164) had positive tests, whereas 41% (62/153) of men had positive tests (P=0.002). At 4 months, women were less likely to have suffered the combined endpoint of subsequent myocardial infarction, revascularization, or death, than men (15 vs. 23%, P=0.027). Events were more likely to occur in patients who had further testing, and especially in those who had positive testing.
Conclusions:
These data suggest that women admitted with chest pain are less likely to have active coronary artery disease, and much less likely to have poor outcomes at 4 months than men. This apparent 'gender protection' effect warrants further study.
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