title: Are we using cardiovascular medications and coronary angiography appropriately in men and women with chest pain?
abstract: OBJECTIVE
  The main purpose of the present study was to analyse the contemporary use of cardiovascular medications and diagnostic coronary angiography in men and women with suspected coronary artery disease (CAD). Furthermore, we examined the association of outcomes (death, myocardial infarction, repeat coronary angiography, procedural complications) with angiographic findings.
  
  
  METHODS
  All patients with stable chest pain (n = 12 200) referred for a first-time elective diagnostic coronary angiography during 2006-08 and registered in the Swedish Coronary Angiography and Angioplasty Register (SCAAR) were included. Significant CAD was defined as ≥ 50% luminal narrowing in any epicardial coronary artery.
  
  
  RESULTS
  In the youngest age group (≤ 59 years), more women than men (78.8 vs. 42.3%, P< 0.001) had normal/non-significant CAD, whereas more men had either left-main or three-vessel disease (18.2 vs. 4.2%, P < 0.001). Event rates were similarly low for men and women with normal/non-significant CAD, except for a higher procedural complication rate in women. Prior to angiography, fewer women than men with high-risk features were prescribed aspirin (83 vs. 86.1%, P = 0.001).
  
  
  CONCLUSIONS
  In women, normal/non-significant CAD was highly prevalent, especially among younger women, and associated cardiovascular event rates were low. In men, findings of advanced disease were more common than in women, even younger men. Fewer high-risk women than men were initially prescribed aspirin. The observed sex differences suggest a need for improved identification of women appropriate for investigation with coronary angiography, earlier diagnostics in men, and heightened attention in the evidence-based use of aspirin in risk patients, especially women.
authors.affiliation: Department of Medical Sciences, Cardiology, Cardiothoracic Center, Uppsala University Hospital 751 85 Uppsala, Sweden. nina.johnston@akademiska.se
authors.forename: Nina
authors.initials: N
authors.lastname: Johnston
authors.forename: Karin
authors.initials: K
authors.lastname: Schenck-Gustafsson
authors.forename: Bo
authors.initials: B
authors.lastname: Lagerqvist
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D060050:Angina, Stable / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011379:Prognosis; D019233:Retreatment; D012307:Risk Factors; D017678:Sex Distribution; D013548:Sweden / Q000453:epidemiology; D019564:Unnecessary Procedures
chemical_list: D002317:Cardiovascular Agents