GENDER DIFFERENCES IN THE NONINVASIVE EVALUATION AND MANAGEMENT OF PATIENTS WITH SUSPECTED CORONARY-ARTERY DISEASE

Objective: To determine if gender-based differences exist in the post- test management and clinical outcome of patients with clinically suspe cted coronary artery disease who have stress electrocardiographic or m yocardial perfusion imaging evaluation. Design: Retrospective cohort s tudy. Setting: University medical center. Patients: From a cohort of 3 975 middle-aged patients referred for outpatient stress testing, 840 ( 47% women) were evaluated noninvasively for clinically suspected coron ary artery disease. Measurements: The rates of subsequent diagnostic p rocedures and the incidence of subsequent coronary revascularization, myocardial infarction, or cardiac death were determined for women and men. Results: Pretest cardiac risk profiles were similar, except hyper tension and hypercholesterolemia were more frequent in women. Atypical angina was more common in women than in men (57.5% compared with 44.5 %, respectively; P < 0.001). Rates of initial test positivity (defined as exercise-induced horizontal or downsloping ST-segment depression g reater than or equal to 1.0 mm or greater than or equal to 1 reversibl e thallium-201 defect) were similar in women and men. Compared with me n, most women with an initial positive test result had no additional c oronary artery disease evaluation (62.3% compared with 38.0%; P = 0.00 2). Coronary revascularization procedures were done more frequently in men (4.9% [22 of 449] compared with 2.0% [8 of 391]; P = 0.03). Cardi ac death or myocardial infarction occurred more often in women during 2 years of follow-up (6.9% [27 of 391] compared with 2.4% [11 of 449]; P = 0.002). Conclusions: Women with suspected coronary artery disease have fewer additional diagnostic tests than men after an initial abno rmal noninvasive stress test result, even though the incidence of typi cal angina, cardiac risk factors, and initial diagnostic test positivi ty rates are similar.