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

• 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
• Journal Title: IJC Heart and Vasculature
• Volume: Volume 27
• Publisher: Elsevier | 2020-04-01, Pages 100502-100502
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.ijcha.2020.100502
• Subjects: Health Sciences, Pathology; Health Sciences, Public Health; Health Sciences, Medicine and Surgery; Biology, Physiology
• Keywords: Angina; Coronary artery disease; Mortality

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.