Elsevier

American Heart Journal

Volume 155, Issue 2, February 2008, Pages 375-381
American Heart Journal

Clinical Investigation
Acute Ischemic Heart Disease
Angina with “normal” coronary arteries: Sex differences in outcomes

https://doi.org/10.1016/j.ahj.2007.10.019Get rights and content

Background

Several studies have demonstrated that women with nonobstructive coronary disease have a high rate of subsequent investigations, rehospitalizations for recurrent chest pain, and repeat coronary angiography. The sex specificity of this finding is unclear. We therefore undertook an evaluation of sex differences in rehospitalization for acute coronary syndrome (ACS) or chest pain in patients with “angiographically normal” coronaries.

Methods

A retrospective cohort study using prospectively collected angiographic and clinical data on all patients in British Columbia, Canada, presenting for their first cardiac catheterization with suspected ischemic heart disease but angiographically normal coronaries.

Results

Among 32 856 patients, 7.1% of men versus 23.3% of women were angiographically normal (P < .001). Among angiographically normal patients, women were older and more likely to present with hypertension, prior stroke, chronic obstructive pulmonary disease, and peripheral vascular disease than men, but Canadian Cardiovascular Society class of angina did not vary by sex. Within 1 year, 1.0% died, (19 women, 18 men, P = .27) and 0.6% had a stroke (13 women, 9 men, P = .91). Readmission to hospital for ACS or chest pain requiring catheterization was significantly higher in women compared to men (adjusted OR 4.06; 95% CI 1.15-14.31).

Conclusions

In a contemporary, population-based cohort presenting for cardiac catheterization for suspected ischemia, women with angiographically normal coronaries were >4 times more likely to be readmitted to hospital for ACS/chest pain within 180 days compared to men. The observed sex difference has important social and economic implications and suggests that traditional diagnostic methods may not be optimal for women.

Section snippets

Population

All patients presenting for cardiac catheterization in the province of British Columbia (BC), Canada, between July 1, 1999, and December 31, 2002, were eligible for the study. The study cohort was identified from the BC Cardiac Registry (BCCR), which prospectively captures information on all cardiac catheterization procedures performed in BC. All procedures are performed at one of 6 centers. Dedicated personnel enter detailed demographic, procedural, and clinical information on each patient

Results

We identified 32 856 patients who underwent an index, or first, coronary angiography for stable coronary disease or ACS. Among men, 7.1% had angiographically normal coronaries compared to 23.3% of women (P < .001). The final study cohort comprised 3647 patients (11.1% of total angiograms for these indications). Angiographically normal patients were more likely to present for catheterization with stable angina (56.7%) than patients with visible epicardial disease (38.7%) (P < .001). This pattern

Discussion

Just over 11% of patients presenting for their first cardiac catheterization, with ACS or stable angina, had angiographically normal coronaries in this population-based cohort. Women were 3 times more likely to be categorized as angiographically normal compared to men. Importantly, even after adjustment for differences in baseline characteristics, women were >4 times more likely than men to be readmitted to hospital for ACS or chest pain requiring cardiac catheterization within 180 days. We

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    Dr Humphries is a Research Scholar funded by the Michael Smith Foundation and the Canadian Institutes of Health Research.

    Dr Pilote is a Research Scholar funded by the Canadian Institutes of Health Research and the William Dawson Professor of Medicine at McGill University.

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