VALUE OF A SIMPLE MEASURE OF ESTROGEN STATUS FOR IMPROVING THE DIAGNOSIS OF CORONARY-ARTERY DISEASE IN WOMEN

PURPOSE: To determine the potential impact of estrogen status on the p retest and postexercise test diagnostic accuracy of exercise testing. PATIENTS AND METHODS: The study comprised a total of 234 women and 326 men who underwent exercise testing followed by coronary angiography. We performed incremental logistic regression analysis of pretest (age, symptoms, smoking, diabetes, cholesterol level) with and without estr ogen status (defined according to menopausal and oral estrogen status) and exercise test (two ST-segment and three non-ST-segment) variables separately for men and women. Outcomes were as assessed by receiver o perating characteristic (ROC) curve area analysis. RESULTS: Estrogen s tatus was an independent pretest predictor of angiographic coronary di sease. Pretest ROC curve areas: women without estrogen status = 0.79, women with estrogen status = 0.85, men = 0.78 (women with estrogen sta tus versus other groups, p <0.001). Postexercise test ROC curve areas. women without estrogen status = 0.83, women with estrogen status = 0. 87, men = 0.88 (women without estrogen status versus other groups, p < 0.001). CONCLUSION: Consideration of estrogen status allowed for a sig nificant improvement in the pretest clinical diagnosis of coronary dis ease in women. When these improvements were added to the results of ex ercise testing, the diagnostic accuracy of the combined clinical and e xercise test data was similar for men and women. Estrogen status may b e an important diagnostic clinical variable in women with suspected co ronary disease.