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Coronary heart disease in women: gender differences in diagnostic evaluation
1Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Insights
Women with chest pain have worse outcomes and receive fewer invasive procedures than men. This review guides noninvasive testing for women with chest pain syndromes, addressing diagnostic disparities.
Area of Science:
- Cardiology
- Women's Health
- Diagnostic Imaging
Background:
- Women experiencing coronary events show less favorable outcomes compared to men.
- Underutilization of invasive diagnostic and therapeutic interventions is documented in women, despite comparable or severe symptoms.
- Optimal evaluation strategies for women with chest pain remain unclear.
Purpose of the Study:
- To review available information guiding the selection of noninvasive diagnostic tests for women presenting with chest pain syndromes.
- To highlight clinical variables, including chest pain characteristics and coronary risk profiles, relevant to diagnostic test selection.
- To address concerns regarding less aggressive diagnostic evaluations in women, potentially impacting access to revascularization.
Main Methods:
- Literature review focusing on noninvasive testing for women with chest pain.
- Analysis of clinical variables influencing diagnostic test selection.
- Examination of the relationship between diagnostic evaluation and treatment access.
Main Results:
- Noninvasive test selection for women with chest pain should consider clinical variables like chest pain characteristics and risk factors.
- Coronary arteriography is a key factor in accessing myocardial revascularization procedures.
- Women with chest pain may undergo less aggressive diagnostic evaluations, even with abnormal noninvasive test results.
Conclusions:
- The optimal noninvasive diagnostic approach for women with chest pain requires further elucidation.
- Gender differences in diagnostic testing may contribute to worse prognoses for women with coronary disease.
- Further research is needed to delineate the role of gender in diagnostic testing and its impact on clinical outcomes.
Abstract:
Although women who sustain coronary events (myocardial infarction, coronary bypass graft surgery, or percutaneous transluminal coronary angioplasty) have less favorable outcomes than do their male counterparts, the optimal approach to the evaluation of women with chest pain has not yet been ascertained. There is substantial documentation of the lesser use of invasive diagnostic and therapeutic interventions for women than for men, despite symptoms of comparable or greater severity among women. This report reviews the information available to guide the selection of noninvasive test procedures for women with chest pain syndromes, highlighting clinical variables, particularly the characteristics of the chest pain and the coronary risk profile. Because coronary arteriography appears to be a major determinant of access to myocardial revascularization procedures, the less aggressive diagnostic evaluation of women with chest pain in general, and of those with abnormal noninvasive test results in particular, remains of concern. The role of gender differences in diagnostic testing in determining the worse prognosis of clinically manifest coronary disease in women has yet to be delineated.