Sex differences in investigation results and treatment in subjects referred for investigation of chest pain

Objective-To evaluate differences in investigation results and treatment be tween men and women referred for diagnostic treadmill exercise testing and coronary arteriography. Design-Cohort study. Setting-Tertiary cardiology centre. Subjects-1522 subjects referred by primary care physicians to an open acces s chest pain clinic for initial investigation of chest pain, of whom 485 we re subsequently referred for coronary arteriography; and a similar cohort o f 107 subjects referred directly by secondary care physicians for diagnosti c coronary arteriography. Main outcome measures-Rates of positive exercise tests and rates for referr al for arteriography and revascularisation according to sex. Results-Overall, women were less likely to be referred for arteriography an d revascularisation than men. However, men were more likely to have positiv e exercise tests, and for various exercise test diagnostic end points men w ere also more likely to have significant coronary artery disease. After tak ing this into account, there was no sex difference in referral rates for ar teriography or revascularisation. Conclusions-There was no evidence of a sex bias resulting in inappropriate underinvestigation or undertreatment of women. However, the positive predic tive value of treadmill exercise testing is low for women and further resea rch is needed into how best to investigate women with chest pain.