Differences in the clinical performance and initial diagnosis in women with suspected coronary artery disease

Background and objective: Although coronary heart disease (CHD) is a major cause of morbidity and mortality, it is still being underestimated in women . This prospective study was undertaken to ascertain special features of th e symptoms and in the initial diagnosis of CHD in women. Patients and methods: Between January 1996 and August 1998, a total of 5000 patients (2500 women, 2500 men; mean age 61 [39-83]) were admitted for the ir initial invasive investigation of suspected CHD. All data relating to hi story, laboratory tests, resting and exercise EGG, and coronary angiography were recorded and analysed. Results: Typical angina pectoris as initial symptom was recorded in 40% of women, 57% of men, atypical symptoms in 48% vs. 24%. Typical angina pectori s in the presence of demonstrated CHD were found in 32% of women, compared with 69% in men. The interval from initial symptoms to established diagnosi s was 68 months in women and 9 months in men, 71% of women but only 5% of m en having consulted at least two specialists. Both women and men with CHD h ad comparable risk factors. Anginal symptoms prematurely ended an exercise ECC test in 49% of women and 44% of men. Significant S-T segment changes we re noted in 19% of women, 30% of men with CHD. The positive predictive valu e of clinical symptoms and ergometric results with regard to CHD was much l ower in women than in men: 33% vs 85%. Conclusions: Clinical symptoms and the exercise ECC are much less diagnosti cally reliable in women than in men and had a very low predictive value. Wo men often have typical anginal symptoms even in the absence of CHD. They, t herefore, require more sensitive methods than the exercise ECC for the init ial diagnosis of CHD, especially in the face of prolonged symptom-to-diagno sis intervals.