SEX AND DIAGNOSTIC EVALUATION OF POSSIBLE CORONARY-ARTERY DISEASE AFTER EXERCISE TREADMILL TESTING AT ONE ACADEMIC TEACHING CENTER

Controversy exists as to whether a sex bias exists that affects the di agnostic approach to suspected coronary artery disease: previous studi es have used coronary angiography, but not other noninvasive testing, as a primary end point. This investigation examined posttest sex diffe rences in diagnostic evaluation after exercise treadmill testing accor ding to a broader end point than lust coronary angiography alone. The design was a cohort analytic study with a 90-day follow-up. The study was done at the Cleveland Clinic Foundation, an academic group practic e. Patients included consecutive adults (1023 men and 579 women) with chest pain but no documented coronary disease who were referred for sy mptom-limited exercise treadmill testing without adjunctive imaging; n one had undergone prior invasive cardiac procedures. Main outcome meas ures included (1) performance of any subsequent diagnostic study (inva sive or noninvasive) and (2) performance of coronary angiography as th e next diagnostic study. During follow-up, 89 (8.7%) men and 48 (8.3%) women underwent a second diagnostic study (odds ratio 0.95; 95% confi dence interval 0.66 to 1.37; p > 0.8), whereas 64 (6.3%) men and 21 (3 .6%) women went straight to coronary angiography (odds ratio 0.56; 95% confidence interval 0.34 to 0.93; p = 0.02). In multivariable logisti c regression analyses, which considered baseline clinical characterist ics, the ST-segment response, and other prognostically important exerc ise responses, women tended to be less likely than men to be referred to any second test (adjusted odds ratio 0.70; 95% confidence interval 0.42 to 1.19; p > 0.1) but were markedly and significantly less likely to be referred straight to coronary angiography (adjusted odds ratio 0.33; 95% confidence interval 0.17 to 0.65). After exercise treadmill testing, women were only slightly less likely than men to be referred for subsequent diagnostic testing; they were, however, much less likel y to be referred straight to coronary angiography as opposed to anothe r noninvasive study.