Author + information
- Ahmed Aziz,
- Henrik Hansen,
- Udo Sechtem,
- Eva Prescott and
- Peter Ong
Background: Ischemic heart disease without obstructive coronary artery disease (CAD) is a frequent cause of angina pectoris in women. Coronary vasomotor disorders (VMD) is presumed to be an important pathological mechanism but has mainly been studied in Asian populations.
Objective: The aim of this study was to determine whether the prevalence and clinical presentation of VMD differs in men and women in a European population without CAD.
Methods: We included 1379 patients with angina, no significant CAD (<50% stenosis) and acetylcholine (ACH) test performed for assessment of coronary microvascular dysfunction (CMD – reproduction of symptoms, ECG changes, and no epicardial spasm) and epicardial vasospasm (EV >75% diameter reduction and ECG changes with reproduction of symptoms). The predictive value of gender, risk factors, symptoms and results of non-invasive tests were analyzed by means of logistic regression.
Results: Mean age was 62, 42% were male and 47% had stable angina. 813 (59%) had a pathological ACH test, 458 (33%) for CMD and 355 (26%) for EV. A pathological ACH test was more common in women (70%) than men (43%, p<0.001). The gender difference was most pronounced for CMD with an age-adjusted female-male ratio of 3.1 (95% CI 2.43- 4.05). Prevalence of test-positive CMD was higher in patients with exercise related symptoms (OR 1.83, 95% CI 1.36- 2.47) and in patients with a positive stress-test (OR 1.40, 95% 1.00-1.98). The ability of these variables to predict CMD was modest with AUC of 0.67. 28% of the women vs 23% of the men had positive test for EV (p=0.04). In an adjusted model OR for gender was 1.30 (95% CI 1.00- 1.69) while symptoms and stress test were not significant predictors (AUC 0.55). Women were more sensitive to acetylcholine with EV occurring at lower doses compared to men. Using a lower cut-off acetylcholine dose for EV the adjusted OR for women vs men was 2.19 (95% CI 1.50-3.18).
Conclusions: Women have a higher prevalence of EV and especially CMD compared to men in a European population with no CAD. Symptoms and results of stress testing are moderately associated with CMD but not with EV. Symptoms, risk factors and noninvasive stress tests can not reliably identify the patients with EV or CMD.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Unusual Presentations of ACS
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1297-328
- 2017 American College of Cardiology Foundation