Are we using cardiovascular medications and coronary angiography appropriately in men and women with chest pain?

Area of Science:

• Cardiology
• Medical Diagnostics
• Health Outcomes Research

Background:

• Coronary artery disease (CAD) diagnosis relies on clinical suspicion and diagnostic procedures.
• Sex-based differences in cardiovascular disease presentation and outcomes are increasingly recognized.
• Understanding contemporary treatment and diagnostic patterns is crucial for optimizing patient care.

Purpose of the Study:

• To analyze current use of cardiovascular medications and coronary angiography in men and women with suspected CAD.
• To investigate the association between angiographic findings and patient outcomes.
• To identify sex-specific differences in diagnostic patterns and treatment initiation.

Main Methods:

• Analysis of 12,200 patients undergoing first-time elective diagnostic coronary angiography (2006-2008) from the Swedish Coronary Angiography and Angioplasty Register (SCAAR).
• Definition of significant CAD as ≥ 50% luminal narrowing in any epicardial coronary artery.
• Comparison of outcomes (death, myocardial infarction, repeat angiography, complications) and medication use between sexes.

Main Results:

• Younger women (≤59 years) more frequently presented with normal/non-significant CAD (78.8%) compared to men (42.3%).
• Men, including younger men, were more likely to have left-main or three-vessel disease (18.2% vs. 4.2%).
• Women with normal/non-significant CAD had higher procedural complication rates; fewer high-risk women received aspirin pre-angiography.

Conclusions:

• Normal/non-significant CAD is highly prevalent in women, particularly younger women, with low associated cardiovascular event rates.
• Advanced CAD findings are more common in men compared to women.
• There is a need for improved identification of women for coronary angiography, earlier diagnostics in men, and optimized aspirin use in high-risk patients, especially women.