Defining low risk for coronary heart disease among women with chest pain syndrome: a prospective evaluation.
BACKGROUND
A better understanding of the clinical manifestations of coronary disease in women may lead to earlier recognition and better outcomes.


METHODS
One hundred fifty-eight women coming to primary care physicians, emergency rooms, or cardiology clinics with undefined chest pain and at least two risk factors underwent detailed clinical evaluation of risk factor profile and symptom characteristics as well as stress testing. The significance of the presenting symptoms was evaluated on the basis of clinical events during an average 26.2 months of follow-up. Noncardiac pain was diagnosed on the basis of spontaneous resolution of symptoms, establishment of an alternative diagnosis, or negative coronary angiography. Cardiac chest pain was established by the development of cardiac clinical events or angiographic demonstration of coronary disease.


RESULTS
Noncardiac chest pain was established in 128 (81%) patients. The remaining 30 (19%) either were found to have had cardiac chest pain or remain symptomatic without definitive diagnosis. Multivariate analysis revealed that noncardiac chest pain was best predicted by a combination of nondiabetic status and negative stress testing. The clinical characteristics of the chest pain syndrome were not significant contributors.


CONCLUSIONS
In nondiabetic women with chest pain syndrome and at least two other cardiac risk factors, a negative stress test predicts a benign course in over 2 years of follow-up.
Sanfilippo
Anthony J
AJ
Department of Medicine and Cardiology, Queen's University, Kingston, Canada. ajs@post.queensu.ca
Abdollah
Hoshiar
H
Knott
Christine
C
Link
Catherine
C
Hopman
Wilma
W
D000328:Adult; D000368:Aged; D002170:Canada; D002637:Chest Pain / Q000209:etiology*; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D006973:Hypertension / Q000150:complications; D008019:Life Style; D008487:Medical History Taking; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects; D016387:Women's Health