Unstable coronary artery disease in post-menopausal women. Identifying patients with significant coronary artery
K Säfström1, N E Nielsen, A Björkholm
1Department of Cardiology, University Hospital, Linköping, Sweden.
Insights
In post-menopausal women with unstable angina, ECG and exercise tests can reliably identify coronary artery disease. ST changes and low exercise capacity strongly predict significant blockages, with high positive predictive values.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Women's Health
Background:
- Electrocardiogram (ECG) and exercise stress tests are less reliable in women for diagnosing coronary heart disease due to higher false-positive rates.
- This is often attributed to a lower pre-test probability of coronary artery disease in women.
Purpose of the Study:
- To assess the diagnostic utility of clinical parameters, resting ECG, and exercise testing in post-menopausal women presenting with unstable coronary artery disease symptoms.
- To identify patients with significant coronary artery stenoses using these diagnostic tools.
Main Methods:
- Prospective study of 200 post-menopausal women admitted with unstable coronary artery disease symptoms and ischemic ECG changes.
- Assessed diagnostic value of risk factors, myocardial enzymes, and early exercise tests.
- Coronary angiography performed within 60 days to confirm diagnoses.
Main Results:
- 71% of patients had at least one significant coronary artery stenosis (>= 50% luminal diameter reduction).
- Relative ST depression (>= 0.1 mV) on resting ECG and low maximum workload during exercise were strong predictors of significant coronary artery disease.
- Positive predictive value for ST depression was 91%; for low maximum workload, it was 84%.
Conclusions:
- Post-menopausal women with unstable angina and resting ECG ischemia signs exhibit a high prevalence (85%) of coronary atherosclerosis.
- Early exercise test ST-T changes, particularly combined with a low maximum workload, demonstrated a high positive predictive value, contradicting some earlier studies and showing no false positives.
Background:
The diagnostic information from an ECG taken while at rest and an exercise test is considered less reliable in women than in men, mostly due to a high percentage of false-positive tests. This can be explained by a lower pre-test likelihood of coronary heart disease.
Aims:
To evaluate the diagnostic information that can be gained from basic clinical parameters, an ECG and exercise test in a group of post-menopausal women with symptoms of unstable coronary artery disease in order to identify patients with significant coronary artery stenoses.
Methods And Results:
We prospectively studied 200 post-menopausal women admitted to the coronary care unit with symptoms of unstable coronary artery disease and ECG changes suggestive of ischaemia. The diagnostic value of common risk factors, myocardial enzymes and an early exercise test were assessed. A coronary angiogram was performed within 60 days. Median age was 67 years. On admission, 38% had ST depression on an ECG taken while at rest, 76% had T-wave inversion, and 41% increased enzyme levels. The coronary angiogram revealed that 15% had no atherosclerosis, 14% had atherosclerosis but not lesion > or = 50% of luminal diameter and 71% had at least one significant stenosis. Of patients with known indicators of atherosclerotic disease, all but one had atherosclerosis visualized on the coronary angiogram. A relative ST depression > or = 0.1 mV and a low maximum workload at exercise test were strong predictors of significant coronary artery disease. The positive predictive value of ST depression was 91% and of low maximum workload 84%
Conclusion:
In post-menopausal women with signs of unstable angina and ischaemia on an ECG taken while at rest, the prevalence of coronary atherosclerosis is high, 85%. Contrary to earlier studies, ST T-changes at the early exercise test had a high positive predictive value, especially in combination with a low maximum workload with no false-positive results.
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