Female sex: a protective role in suspected myocardial ischemia.
OBJECTIVE
Women are felt to have poor outcomes in coronary artery disease, largely on the basis of secondary observations in acute coronary syndrome trials. We sought to examine the neglected topic of sex differences in workup and outcomes in the general population presenting with chest pain.


METHODS
We examined 439 consecutive patients admitted via the emergency department with ongoing chest pain. Cardiac testing was defined as any cardiac catheterization or stress test. Positive testing was defined as a 70% or greater stenosis in an epicardial coronary artery on catheterization, or a positive stress test result. Follow-up was obtained via telephone contact at 4 months following discharge.


RESULTS
Further cardiac testing was deemed necessary in 68% (164/241) of women and 77% (153/198) of men (P=0.038). Among women undergoing further testing, only 21% (35/164) had positive tests, whereas 41% (62/153) of men had positive tests (P=0.002). At 4 months, women were less likely to have suffered the combined endpoint of subsequent myocardial infarction, revascularization, or death, than men (15 vs. 23%, P=0.027). Events were more likely to occur in patients who had further testing, and especially in those who had positive testing.


CONCLUSIONS
These data suggest that women admitted with chest pain are less likely to have active coronary artery disease, and much less likely to have poor outcomes at 4 months than men. This apparent 'gender protection' effect warrants further study.
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA. chenriks@jhmi.edu
Charles A
CA
Henrikson
Eric E
EE
Howell
David E
DE
Bush
Nisha
N
Chandra-Strobos
D001241:Aspirin / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000175:diagnosis; D003935:Diagnostic Techniques, Cardiovascular; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000188:drug therapy; D012737:Sex Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D000960:Hypolipidemic Agents; D001241:Aspirin