PROGNOSTIC VALUE OF NONINVASIVE RISK STRATIFICATION IN YOUNGER AND OLDER PATIENTS REFERRED FOR EVALUATION OF SUSPECTED CORONARY-ARTERY DISEASE

OBJECTIVES: The purpose of this investigation is to explore the relati onship of patient gender and age on coronary artery disease diagnostic evaluation and to assess the impact of noninvasive testing results on coronary revascularization rates and cardiac event-free survival. STU DY DESIGN: Retrospective observational cohort. PARTICIPANTS: From a se ries of 5322 consecutively tested patients from a Midwestern universit y tertiary medical center, a hospital cohort of 1345 patients with cli nically suspected coronary artery disease was enrolled from 1988 throu gh 1989. MEASUREMENTS AND RESULTS: Cardiac risk factor and symptom pro files were worse in women, whereas rates of positive test results were similar in both sexes. Multivariable-adjusted risk for follow-up diag nostic testing was 1.8 and 1.9 times greater, respectively, for men le ss than or equal to and > 65 years of age than for women (P < .01). Yo unger women were 4.9 times (P = .001) more likely to experience a card iac event than younger men, with no differences between younger and ol der women (relative risk = 1.1; P > .20). Overall cardiac event rates were 2.3, 7.4, 16.7, and 20.2% for young men, young women, older women , and older men, respectively. Initial screening was delayed 2 to 7 ti mes longer for older and younger women compared with men (P < .001); t he greatest delays were observed for younger women. Diagnostic follow- up and subsequent cost of total care from initial evaluation through 2 years of follow-up were higher for men than for women (P < .0001), wi th older women having the lowest rate of subsequent diagnostic and int erventional follow-up. In the highest risk patients, subsequent utiliz ation rates were 40 and 20% higher for younger and older men than for similarly aged women. In particular, diabetics were less likely to und ergo follow-up diagnostic testing and revascularization (67% younger w omen). CONCLUSIONS: Age appears to significantly and differently influ ence decisions regarding noninvasive and invasive medical service util ization in men and women and may partially account for variable outcom es in this and previous gender-based comparisons.