OBJECTIVES: The aim of this study was to determine whether presentation, risk assessment, testing choices, and results differ by sex in stable symptomatic outpatients with suspected coronary artery disease (CAD). BACKGROUND: Although established CAD presentations differ by sex, little is known about stable, suspected CAD. METHODS: The characteristics of 10,003 men and women in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial were compared using chi-square and Wilcoxon rank-sum tests. Sex differences in test selection and predictors of test positivity were examined using logistic regression. RESULTS:Women were older (62.4 years of age vs. 59.0 years of age) and were more likely to be hypertensive (66.6% vs. 63.2%), dyslipidemic (68.9% vs. 66.3%), and to have a family history of premature CAD (34.6% vs. 29.3) (all p values <0.005). Women were less likely to smoke (45.6% vs. 57.0%; p < 0.001), although their prevalence of diabetes was similar to that in men (21.8% vs. 21.0%; p = 0.30). Chest pain was the primary symptom in 73.2% of women versus 72.3% of men (p = 0.30), and was characterized as “crushing/pressure/squeezing/tightness” in 52.5% of women versus 46.2% of men (p < 0.001). Compared with men, all risk scores characterized women as being at lower risk, and providers were more likely to characterize women as having a low (<30%) pre-test probability of CAD (40.7% vs. 34.1%; p < 0.001). Compared with men, women were more often referred to imaging tests (adjusted odds ratio: 1.21; 95% confidence interval: 1.01 to 1.44) than nonimaging tests. Women were less likely to have a positive test (9.7% vs. 15.1%; p < 0.001). Although univariate predictors of test positivity were similar, in multivariable models, age, body mass index, and Framingham risk score were predictive of a positive test in women, whereas Framingham and Diamond and Forrester risk scores were predictive in men. CONCLUSIONS: Patient sex influences the entire diagnostic pathway for possible CAD, from baseline risk factors and presentation to noninvasive test outcomes. These differences highlight the need for sex-specific approaches for the evaluation of CAD.
RCT Entities:
OBJECTIVES: The aim of this study was to determine whether presentation, risk assessment, testing choices, and results differ by sex in stable symptomatic outpatients with suspected coronary artery disease (CAD). BACKGROUND: Although established CAD presentations differ by sex, little is known about stable, suspected CAD. METHODS: The characteristics of 10,003 men and women in the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial were compared using chi-square and Wilcoxon rank-sum tests. Sex differences in test selection and predictors of test positivity were examined using logistic regression. RESULTS:Women were older (62.4 years of age vs. 59.0 years of age) and were more likely to be hypertensive (66.6% vs. 63.2%), dyslipidemic (68.9% vs. 66.3%), and to have a family history of premature CAD (34.6% vs. 29.3) (all p values <0.005). Women were less likely to smoke (45.6% vs. 57.0%; p < 0.001), although their prevalence of diabetes was similar to that in men (21.8% vs. 21.0%; p = 0.30). Chest pain was the primary symptom in 73.2% of women versus 72.3% of men (p = 0.30), and was characterized as “crushing/pressure/squeezing/tightness” in 52.5% of women versus 46.2% of men (p < 0.001). Compared with men, all risk scores characterized women as being at lower risk, and providers were more likely to characterize women as having a low (<30%) pre-test probability of CAD (40.7% vs. 34.1%; p < 0.001). Compared with men, women were more often referred to imaging tests (adjusted odds ratio: 1.21; 95% confidence interval: 1.01 to 1.44) than nonimaging tests. Women were less likely to have a positive test (9.7% vs. 15.1%; p < 0.001). Although univariate predictors of test positivity were similar, in multivariable models, age, body mass index, and Framingham risk score were predictive of a positive test in women, whereas Framingham and Diamond and Forrester risk scores were predictive in men. CONCLUSIONS:Patient sex influences the entire diagnostic pathway for possible CAD, from baseline risk factors and presentation to noninvasive test outcomes. These differences highlight the need for sex-specific approaches for the evaluation of CAD.
Authors: Roxanne Pelletier; Karin H Humphries; Avi Shimony; Simon L Bacon; Kim L Lavoie; Doreen Rabi; Igor Karp; Meytal Avgil Tsadok; Louise Pilote Journal: CMAJ Date: 2014-03-17 Impact factor: 8.262
Authors: Jennifer H Mieres; Leslee J Shaw; Andrew Arai; Matthew J Budoff; Scott D Flamm; W Gregory Hundley; Thomas H Marwick; Lori Mosca; Ayan R Patel; Miguel A Quinones; Rita F Redberg; Kathryn A Taubert; Allen J Taylor; Gregory S Thomas; Nanette K Wenger Journal: Circulation Date: 2005-02-01 Impact factor: 29.690
Authors: Ralph B D'Agostino; Ramachandran S Vasan; Michael J Pencina; Philip A Wolf; Mark Cobain; Joseph M Massaro; William B Kannel Journal: Circulation Date: 2008-01-22 Impact factor: 29.690
Authors: Umesh N Khot; Monica B Khot; Christopher T Bajzer; Shelly K Sapp; E Magnus Ohman; Sorin J Brener; Stephen G Ellis; A Michael Lincoff; Eric J Topol Journal: JAMA Date: 2003-08-20 Impact factor: 56.272
Authors: Abdulla Shehab; Bayan Al-Dabbagh; Khalid F AlHabib; Alawi A Alsheikh-Ali; Wael Almahmeed; Kadhim Sulaiman; Ahmed Al-Motarreb; Nicolaas Nagelkerke; Jassim Al Suwaidi; Ahmad Hersi; Hussam Al Faleh; Nidal Asaad; Shukri Al Saif; Haitham Amin Journal: PLoS One Date: 2013-02-06 Impact factor: 3.240
Authors: Karen M Goldstein; Karen M Stechuchak; Leah L Zullig; Eugene Z Oddone; Maren K Olsen; Felicia A McCant; Lori A Bastian; Bryan C Batch; Hayden B Bosworth Journal: J Womens Health (Larchmt) Date: 2017-02-13 Impact factor: 2.681
Authors: Tessa S S Genders; Adrian Coles; Udo Hoffmann; Manesh R Patel; Daniel B Mark; Kerry L Lee; Ewout W Steyerberg; M G Myriam Hunink; Pamela S Douglas Journal: JACC Cardiovasc Imaging Date: 2017-06-14
Authors: Lorie M Harper; Meredith Kilgore; Jeff M Szychowski; William W Andrews; Alan T N Tita Journal: Obstet Gynecol Date: 2017-08 Impact factor: 7.661
Authors: Abhinav Sharma; Adrian Coles; Nishant K Sekaran; Neha J Pagidipati; Michael T Lu; Daniel B Mark; Kerry L Lee; Hussein R Al-Khalidi; Udo Hoffmann; Pamela S Douglas Journal: J Am Coll Cardiol Date: 2019-03-05 Impact factor: 24.094