title: Prognostic value of noninvasive risk stratification in younger and older patients referred for evaluation of suspected coronary artery disease.
abstract: OBJECTIVE
  The purpose of this investigation is to explore the relationship of patient gender and age on coronary artery disease diagnostic evaluation and to assess the impact of noninvasive testing results on coronary revascularization rates and cardiac event-free survival.
  
  
  METHODS
  Retrospective observational cohort.
  
  
  METHODS
  From a series of 5322 consecutively tested patients from a Midwestern university tertiary medical center, a hospital cohort of 1345 patients with clinically suspected coronary artery disease was enrolled from 1988 through 1989.
  
  
  RESULTS
  Cardiac risk factor and symptom profiles were worse in women, whereas rates of positive test results were similar in both sexes. Multivariable-adjusted risk for follow-up diagnostic testing was 1.8 and 1.9 times greater, respectively, for men < or = and > 65 years of age than for women (P < .01). Younger women were 4.9 times (P = .001) more likely to experience a cardiac event than younger men, with no differences between younger and older women (relative risk = 1.1; P > .20). Overall cardiac event rates were 2.3, 7.4, 16.7, and 20.2% for young men, young women, older women, and older men, respectively. Initial screening was delayed 2 to 7 times longer for older and younger women compared with men (P < .001); the greatest delays were observed for younger women. Diagnostic follow-up and subsequent cost of total care from initial evaluation through 2 years of follow-up were higher for men than for women (P < .0001), with older women having the lowest rate of subsequent diagnostic and interventional follow-up. In the highest risk patients, subsequent utilization rates were 40 and 20% higher for younger and older men than for similarly aged women. In particular, diabetics were less likely to undergo follow-up diagnostic testing and revascularization (67% younger women).
  
  
  CONCLUSIONS
  Age appears to significantly and differently influence decisions regarding noninvasive and invasive medical service utilization in men and women and may partially account for variable outcomes in this and previous gender-based comparisons.
authors.affiliation: Department of Internal Medicine, Duke University Medical Center, Durham, NC 27705, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: D D
authors.initials: DD
authors.lastname: Miller
authors.forename: J C
authors.initials: JC
authors.lastname: Romeis
authors.forename: L T
authors.initials: LT
authors.lastname: Younis
authors.forename: K N
authors.initials: KN
authors.lastname: Gillespie
authors.forename: J R
authors.initials: JR
authors.lastname: Kimmey
authors.forename: B R
authors.initials: BR
authors.lastname: Chaitman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors