Differences in presentation and diagnosis of coronary artery disease in women

Introduction: Coronary artery disease (CAD) in women is the most common cause of death in developed countries. Sex differences in terms of clinical presentation, diagnosis and treatment of CAD have been shown in recent works, which alerts us about a dissociation between perceived and real risk. Objectives: The aim of this study is to analyze the characteristics of the study population by gender, to correlate the symptoms previous to the study and the results of stress testing with myocardial perfusion and to assess the impact of positive results of myocardial perfusion by scores of risk as the indication of coronary angiography (CAG). Methods: A retrospective analysis of patients referred to the Section of Nuclear Medicine for a myocardial perfusion SPECT was conducted. To study the population we divided it according to sex and assessed the reason for the visit: asymptomatic, non-typical chest pain (NTP) and typical pain (TP), cardiovascular risk factors, the results of stress test, and the results of the SPECT study. We followed up for 2 months those patients with myocardial perfusion SPECT (+) as the indication of CAG. Results: 700 patients were included. Men n 456 (66%) women n 244 (34%) p: 0.0001; no significant differences were found between sexes in high blood pressure, smoking and diabetes; dyslipidemic men n=241 (53%) vs women n 158 (65%) p=0.003; Asymptomatic men n 243 (54%) vs. 76 women n (31%), p=0.0001; NTP men n 123 (26%) vs. women n 120 (49 %), p 0.0001, TP men n 90 (20%) vs. women n 48 (20%), p ns. Stress test was positive in 127 men (27%) and 59 women (24%), p ns, while it was negative in 329 men (73%) and 185 women (76%), p ns. The SPECT test was positive in 242 patients; 187 (77%) men vs. 55 (23%) women p: 0.0001. When we compared the clinical presentation and positive SPECT test we found no significant differences between the sexes. Subsequently we evaluated patients with positive stress test and SPECT test found in 127 men (68%) and only 25 women (45%), p 0.003, then compared positive stress test and negative SPECT test and found 60 men (32%) and 30 women (54 %), p 0.005. Of all women screened, 22% (n 55) showed SPECT test (+), of which 13% (n 11) underwent CAG; within this group, CAG was prescribed mainly to patients with SDS> 5 (moderate -high risk), 4 pt (27%) vs. 11 p t(73%) that did not undergo CAG p: 0.03. Conclusions: Female patients are referred less often than men for the evaluation of CAD in our service. The most frequent symptom in women is NTP. Typical chest pain and positive stress test in women are not good predictors of myocardial ischemia as perfusion studies compared to the male population. Women have a low rate of angiographic indication.