Not typical angina and mortality in women with obstructive coronary artery disease: Results from the Women's Ischemic Syndrome Evaluation study (WISE)

• Type of Material: Article
• Authors: Erika Jones, Cedars-Sinai Medical Center; B. Delia Johnson, University of Pittsburgh; Leslee Shaw, Emory University; May Bakir, Cedars-Sinai Medical Center; Janet Wei, Cedars-Sinai Medical Center; Puja Mehta, Emory University; Margo Minissian, Cedars-Sinai Medical Center; Carl J. Pepine, University of Florida; Steven E. Reis, University of Pittsburgh; Sheryl F. Kelsey, University of Pittsburgh; Eileen Handberg, University of Florida; Vera Bittner, University of Alabama at Birmingham; George Sopko, National Heart, Lung, and Blood Institute (NHLBI); C. Noel Bairey Merz, Cedars-Sinai Medical Center
• Language: English
• Date: 2020-04-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2020 the Authors. Published by Elsevier B.V.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijcha.2020.100502
• Title of Journal or Parent Work: IJC Heart and Vasculature
• Volume: 27
• Start Page: 100502
• End Page: 100502
• Grant/Funding Information: Dr. Pepine was also supported by National Institute of Health grants HL33610, HL56921; UM1 HL087366; the Gatorade Trust through funds distributed by the University of Florida, Department of Medicine; NIH NCATS—University of Florida Clinical and Translational Science UL1TR001427; and PCORnet-OneFlorida Clinical Research Consortium CDRN-1501-26692.; This work was supported by contracts from the National Heart, Lung and Blood Institutes nos. N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164, grants U0164829, U01 HL649141, U01 HL649241, K23HL105787, T32HL69751, R01 HL090957, 1R03AG032631 from the National Institute on Aging, GCRC grant MO1-RR00425 from the National Center for Research Resources,; National Center for Advancing Translational Sciences Grant UL1TR000124 and UL1TR000064, and grants from the Gustavus and Louis Pfeiffer Research Foundation, Danville, NJ, The Women’s Guild of Cedars-Sinai Medical Center, Los Angeles, CA, The Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, PA, and QMED, Inc., Laurence Harbor, NJ, the Edythe L. Broad and the Constance Austin Women’s Heart Research Fellowships,; Cedars-Sinai Medical Center, Los Angeles, California, the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles, The Society for Women’s Health Research (SWHR), Washington, D.C., The Linda Joy Pollin Women’s Heart Health Program, the Erika Glazer Women’s Heart Research Initiative, and the Adelson Family Foundation, Cedars-Sinai Medical Center, Los Angeles, California.
• Keywords: Mortality; Angina; Coronary artery disease
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Physiology; Health Sciences, Public Health; Health Sciences, Pathology

Abstract

Background: Women frequently present with symptoms not typical of angina (NTA) making ischemic heart disease recognition, diagnosis and treatment challenging. We compared mortality in women with obstructive coronary artery disease (CAD) with NTA vs typical angina (TA). Methods: We studied 326 Women's Ischemia Syndrome Evaluation (WISE) participants undergoing coronary angiography for suspected myocardial ischemia with core-lab measured obstructive CAD. TA was defined as sub-sternal chest pain precipitated by physical exertion or emotional stress and relieved with rest or nitroglycerin; NTA did not meet criteria for TA. The women were followed for non-fatal events and death for a median of 5.9 and 9.6 years respectively. Multivariate cox proportional hazards regression determined relations to events. Results: Overall, 115 (35%) of the women had TA. Baseline demographics, risk factors or additional symptom characteristics were similar between the two angina groups. Non-fatal events did not differ between groups. Women with NTA had a higher mortality compared to TA women (36% vs 26%, respectively, p = 0.047). Despite adjustment for additional major risk variables, NTA was an independent predictor of mortality compared to TA with a hazard ratio of 1.73 (95% Confidence interval: 1.04, 2.89). Conclusions: Among women with suspected ischemia undergoing coronary angiography with obstructive CAD, NTA was more common than TA, and predicted a higher longer-term mortality. Further investigation is needed to confirm these results, and investigate potential explanations for the higher mortality observed in women with NTA women, including lower recognition or action in the setting of obstructive CAD.