UNSTABLE CORONARY-ARTERY DISEASE IN POSTMENOPAUSAL WOMEN - IDENTIFYING PATIENTS WITH SIGNIFICANT CORONARY-ARTERY DISEASE BY BASIC CLINICAL-PARAMETERS AND EXERCISE TEST

Background The diagnostic information from an ECG taken while at rest and an exercise test is considered less reliable in women than in men, mostly due to a high percentage of false-positive tests. This can be explained by a lower pre-test likelihood of coronary heart disease. Ai ms To evaluate the diagnostic information that can be gained from basi c clinical parameters, an ECG and exercise test in a group of post-men opausal women with symptoms of unstable coronary artery disease in ord er to identify patients with significant coronary artery stenoses. Met hods and Results We prospectively studied 200 postmenopausal women adm itted to the coronary care unit with symptoms of unstable coronary art ery disease and ECG changes suggestive of ischaemia. The diagnostic va lue of common risk factors, myocardial enzymes and an early exercise t est were assessed. A coronary angiogram was performed within 60 days. Median age was 67 years. On admission, 38% had ST depression on an ECG taken while at rest, 76% had T-wave inversion, and 41% increased enzy me levels. The coronary angiogram revealed that 15% had no atheroscler osis, 14% had atherosclerosis but no lesion greater than or equal to 5 0% of luminal diameter and 71% had at least one significant stenosis. Of patients with known indicators of atherosclerotic disease, all but one had atherosclerosis visualized on the coronary angiogram. A relati ve ST depression greater than or equal to 0.1 mV and a low maximum wor kload at exercise test were strong predictors of significant coronary artery disease. The positive predictive Value of ST depression was 91% and of low maximum workload 84%. Conclusion In post-menopausal women with signs of unstable angina and ischaemia on an ECG taken while at r est. the prevalence of coronary atherosclerosis is high, 85%. Contrary to earlier studies, ST T-changes at the early exercise test had a hig h positive predictive value, especially in combination with a low maxi mum workload with no false-positive results.