Persistent chest pain predicts cardiovascular events in women without obstructive coronary artery disease: results...

Area of Science:

• Cardiology
• Women's Health
• Clinical Research

Background:

• Women with chest pain and non-obstructive coronary artery disease (CAD) are often considered low risk for cardiovascular events.
• However, a significant proportion experience persistent, debilitating chest pain for many years.
• This highlights a potential gap in understanding and managing cardiovascular risk in this population.

Purpose of the Study:

• To compare cardiovascular (CV) outcomes in women with persistent chest pain (PChP) versus those without PChP.
• To investigate the predictive value of PChP on adverse CV events in women undergoing coronary angiography.
• To identify specific subgroups that may benefit from targeted interventions.

Main Methods:

• A cohort of 673 participants from the Women's Ischaemia Syndrome Evaluation (WISE) study with chest pain and suspected myocardial ischemia were analyzed.
• Participants underwent coronary angiography and had at least one year of follow-up.
• Persistent chest pain (PChP) was defined as self-reported continuing chest pain after one year. Cardiovascular events were recorded for a median of 5.2 years post-initial assessment.

Main Results:

• Among women without obstructive CAD, those with PChP exhibited more than double the rate of composite CV events (including stroke) compared to women without PChP (P = 0.03).
• In contrast, within the subgroup of women with obstructive CAD, no significant difference in composite CV events was observed between those with and without PChP (P = 0.72).
• PChP was associated with increased risk of non-fatal myocardial infarctions and stroke in women without obstructive CAD.

Conclusions:

• Persistent chest pain in women with non-obstructive coronary artery disease undergoing evaluation for suspected myocardial ischemia is a predictor of adverse cardiovascular outcomes.
• These findings suggest that women with PChP and non-obstructive CAD may benefit from further diagnostic evaluation.
• Aggressive risk factor modification therapy should be considered for this patient group to mitigate future cardiovascular events.