Sex-related differences in the angiographic results of 14 500 cases referred for suspected coronary artery disease

Giannoglou, George D.; Antoniadis, Antonios; Chatzizisis, Yiannis S.; Damvopoulou, Efthalia; Parcharidis, George E.; Louridas, George

doi:10.1097/mca.0b013e3282f2629c

Cited by 9 publications

(9 citation statements)

References 21 publications

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“…Importantly, both studies are consistent in their indication of a change in the population characteristics of hospitalized subjects, including a more advanced age (by 3–4 years in SILCARD [ 40 ]) and increasing prevalence of HF (in SILCARD absolute growth by 4.8%, relative growth by 29.3% [ 40 ]). Furthermore, the gender differences depicted in the present study ( Table I ) are similar to those in SILCARD [ 40 ] and those reported in other populations [ 4 , 6 , 26 , 38 , 39 , 41 , 42 ] and are thus consistent with internal integrity of the present data.…”

Section: Discussionsupporting

confidence: 92%

“…Other important observations, consistent with current CAD trends [ 1 ], include a significant increase in the median age (64 vs. 68 years) and the prevalence of heart failure (24.1% vs. 42.2%) increased significantly ( p < 0.001 for both) while the proportion of women admitted for clinically indicated CAG remained similar (40.4% vs. 41.8%; Table I , Figure 1 ). As expected [ 6 , 27 ], atherosclerotic coronary artery lesions, for all stenosis categories (i.e., any angiographic atherosclerosis, lesion(s) ≥ 50% , lesion(s) ≥ 70%, occlusion(s), left main (LM) coronary artery stenosis ≥ 50%) were more prevalent in males ( Table I ).…”

Section: Discussionsupporting

confidence: 82%

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Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resource utilization

Chmiel

Książek

Stryszak

et al. 2018

pwki

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IntroductionInvasive coronary angiography (CAG), the ‘gold standard’ in coronary artery disease (CAD) diagnosis, requires hospitalization, is not risk-free, and engages considerable healthcare resources.AimTo assess recent (throught out 10 years) evolution of ‘significant’ (≥ 50% stenosis(es)) CAD prevalence in subjects undergoing CAG for CAD diagnosis in a high-volume tertiary referral center.Material and methodsAnonymized medical records were compared for the last vs. the first 2-years of the decade (June 2007 to May 2018). Referrals for suspected CAD were 2067 of 4522 hospitalizations (45.7%) and 1755 of 5196 (33.8%) respectively (p < 0.001).ResultsThe median patient age (64 vs. 68 years) and the prevalence of heart failure (24.1% vs. 42.2%) increased significantly (p < 0.001). The CAG atherosclerotic lesions, for all stenosis categories (< 50%; ≥ 50%; ≥ 70%; occlusion(s)), were significantly more prevalent in men. The proportion of subjects with any atherosclerosis on CAG increased (80.7% vs. 77.6%, p = 0.015). However, in the absence of any gross change in, for instance, the fraction of women (40.4% vs. 41.8%), the proportion of CAGs with significant CAD (lesion(s) ≥ 50%) decreased from 55.2% in 2007/2008 to below 1 in every 2 angiograms (48.9%) in 2017/2018 (p < 0.001). This unexpected finding occurred consistently across nearly all CAG referral categories.ConclusionsDespite more advanced age and a higher proportion of subjects with ‘any’ coronary atherosclerosis on CAG, the likelihood of a ‘negative’ angiogram (lesion(s) < 50%; no further evaluation/intervention) has increased significantly over the last decade. The exact nature of this phenomenon requires further investigation, particularly as a reverse trend would be expected with the growing role (and current high penetration) of contemporary non-invasive diagnostic tools to rule out significant CAD.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 82%

Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resource utilization

Chmiel

Książek

Stryszak

et al. 2018

pwki

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“…2). Загалом у чоловічій популяції обструктивне звуження ВА спостерігалося суттєво частіше, ніж у жіночій (78,6 % vs 39,6 %, р<0,001), що цілком узгоджується з даними зарубіжних авторів [14,15].…”

Section: Original Researchunclassified

“…У низці робіт було виявлено статеві відмінності щодо основних анатомічних і патофізіологічних аспектів коронарного атеросклерозу. Так, наприклад, у великому ретроспективному дослідженні [14] за участі 14 450 осіб, яким виконували коронарографію, показано, що гемодинамічно вагомі стенози ВА статистично значуще більш часто реєструвалися у чоловіків (86 % vs 64 %, р<0,001), тоді як інтактні ВА -у жінок (30,4 % vs 5,6 %, р<0,001). Також у представниць жіночої статі рідше було наявне обструктивне ураження ПВА (55,6 % vs 61,9 %, р<0,001) і ОГ ЛВА (46,7 % vs 50 %, р<0,01), однак фактична різниця у показниках становила лише кілька відсотків.…”

Section: Original Researchunclassified

Age and Sex-Related Features of Coronary Atherosclerotic Lesions in Patients With Stable Ischemic Heart Disease and No History of Myocardial Infarction

Svintsitskyi¹

2017

Buk. Med. Herald

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Мета роботи-визначити cтатево-вікові особливості стану вінцевого русла в пацієнтів зі стабільною ішемічною хворобою серця без перенесеного інфаркту міокарда в анамнезі. Матеріал і методи. В одноцентровому крос-секційному дослідженні проаналізовано дані обстеження 118 хворих на стабільну ішемічну хворобу серця (чоловіків-70 (59,3 %), жінок-48 (40,7 %), медіана віку-65 років), яких за статевим принципом було розподілено на дві групи. Усім пацієнтам проводили загальноклінічні, антропометричні, лабораторні обстеження і коронарографію. Результати. У чоловіків відзначалися більш виражені зміни вінцевого русла (за кількістю уражених судин і показником Gensini score) порівняно із жінками, причому це твердження було справедливе в обох вікових категоріях: до і понад 65 років. У них частіше спостерігався множинний коронарний атеросклероз (28,6 % vs 8,3 %, р<0,01), тоді як в осіб жіночої статі-інтактні судини (39,6 % vs 10 %, р<0,001). За локалізацією гемодинамічно вагомих змін вінцевих артерій статистично значущих відмінностей серед представників обох статей не відзначалося: і в чоловіків, і в жінок найчастіше обструкція виникала в передній міжшлуночковій гілці лівої вінцевої артерії, переважно в проксимальній її частині. Висновок. Жіночий патерн стабільної ішемічної хвороби серця характеризується частою відсутністю обструктивного ураження вінцевих артерій, поступовим прогресуванням атеросклеротичних змін вінцевого русла з віком, однак локалізація гемодинамічно вагомих звужень не відрізняється від такої у хворих чоловічої статі.

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“…To date, numerous studies have been performed to explain the underlying mechanisms of CSX. Several possible mechanisms, including but not limited to microvascular dysfunction, platelet hyperactivity, and lactate formation, have been suggested [3,4,5,8,9,10,11,12,13].…”

Section: Introductionmentioning

confidence: 99%

Discrimination between Obstructive Coronary Artery Disease and Cardiac Syndrome X in Women with Typical Angina and Positive Exercise Test; Utility of Cardiovascular Risk Calculators

et al. 2019

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Introduction: Nearly 40% of women with typical angina and a positive exercise tolerance test (ETT) have normal or near normal coronary angiography (CAG) labeled as cardiac syndrome X (CSX). Objective: We performed this study to evaluate the power of common cardiovascular risk calculators to distinguish patients with CSX from those with coronary artery disease (CAD). Methods: 559 women participated in the study. Three risk scores, including (1) newly pooled cohort equation of American College of Cardiology/American Heart Association (ACC/AHA) to predict 10 years risk of first atherosclerotic cardiovascular hard event (ASCVD), (2) Framingham risk score (FRS) for the prediction of 10 years coronary heart disease, and (3) the SCORE tool to estimate 10-year risk of cardiovascular mortality (SCORE), were applied. Results: CAD was diagnosed in 51.5% of the patients. 11.6% of the population had ASCVD < 2.5%, and only 13.8% of these patients had CAD on their CAG. By choosing FRS, 14.4% of patients had FRS < 7.5%, and only 11.3% of these patients had recorded CAD on CAG, while the rest of the patients were diagnosed as CSX. Using the SCORE model, 13.8% of patients had the least value (<0.5%) in whom the prevalence of CAD was 19.9%. The area under receiver operating characteristic curve (AUROC) to discriminate CSX from CAD was calculated for each scoring system, being 0.750 for ASCVD, 0.745 for FRS, and 0.728 for SCORE (p value for all AUROCs < 0.001). The Hosmer–Lemeshow chi squares (df, p value) for calibration were 8.787 (8, 0.361), 11.125 (8, 0.195), and 10.618 (8, 0.224) for ASCVD, FRS, and SCORE, respectively. Conclusions: Patients who have ASCVD < 2.5% or FRS < 7.5% may be appropriate cases for noninvasive imaging (Such as coronary CT angiography). CAG is indicated for patients with ASCVD ≥ 7.5% and FRS ≥ 15%, whereas the patients with intermediate risk need comprehensive patient–physician shared decision-making.

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Sex-related differences in the angiographic results of 14 500 cases referred for suspected coronary artery disease

Abstract: SS were less common in women, were found later in life, and were less likely to involve the right coronary artery, left circumflex, intermediate artery and first obtuse marginal branch than in men.

Cited by 9 publications

References 21 publications

Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resource utilization

Temporal changes in the pattern of invasive angiography use and its outcome in suspected coronary artery disease: implications for patient management and healthcare resource utilization

Age and Sex-Related Features of Coronary Atherosclerotic Lesions in Patients With Stable Ischemic Heart Disease and No History of Myocardial Infarction

Discrimination between Obstructive Coronary Artery Disease and Cardiac Syndrome X in Women with Typical Angina and Positive Exercise Test; Utility of Cardiovascular Risk Calculators

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