Detailed angiographic analysis of women with suspected ischemic chest pain(pilot phase data from the NHLBI-sponsored women's ischemia syndrome evaluation [WISE] study angiographic core laboratory)

The purpose of this study is to provide a contemporary qualitative and quan titative analysis of coronary angiograms from a large series of women enrol led in the Women's Ischemia Syndrome Evaluation (WISE) study who had suspec ted ischemic chest pain. Previous studies have suggested that women with ch est pain have a lower prevalence of significant coronary artery disease (CA D) compared with men. Detailed analyses of angiographic findings relative t o risk factors and outcomes are not available. All coronary angiograms were reviewed in a central core laboratory. Quantitative measurement of percent stenosis was used to assess the presence and severity of disease. Of the 3 23 women enrolled in the pilot phase, 34% had no detectable, 23% had measur able but minimal, and 43% had significant (>50% diameter stenosis) CAD. Of those with significant CAD, most had multivessel disease. Features suggesti ng complex plaque were identified in <10%. Age, hypertension, diabetes mell itus, prior myocardial infarction (MI), current hormone replacement therapy , and unstable angina were all significant, independent predictors of prese nce of significant disease (p <0.05). Subsequent hospitalization for a card iac cause occurred more frequently in those women with minimal and signific ant disease compared with no disease (p = 0.001). The common findings of no and extensive CAD among symptomatic women at coronary angiography highligh t the need for better clinical noninvasive evaluations for ischemia. Women with minimal CAD have intermediate rates of rehospitalization and cardiovas cular events, and thus should not be considered low risk. (C) 2001 by Excer pta Medico, Inc.