Abstract
Background: Women frequently present with non-typical angina (NTA) making ischemia diagnosis and treatment challenging. We hypothesized that mortality would be higher in women with obstructive coronary artery disease (CAD) and NTA vs typical angina (TA). Methods: We studied 364 Women’s Ischemia Syndrome Evaluation (WISE) participants with signs and symptoms of ischemia and obstructive CAD, defined as ≥50% stenosis by WISE angiography core laboratory. TA was defined as sub-sternal chest pain precipitated by physical exertion or emotional stress and relieved with rest or nitroglycerin, while NTA was defined as symptoms not meeting criteria for TA. Death was confirmed by National Death Index. Time to death was analyzed and plotted using Kaplan-Meier survival analyses. The analyses were adjusted by age using a Cox Proportional Hazards regression, and reported with a hazard ratio (HR) and 95% confidence interval (CI). Results: Overall, 249 (68%) NTA and 115 (32%) TA women had a mean age of 63 ± 12yrs and 21% were non-white. Women with NTA were more hypertensive (72% vs. 60%, p=0.03) and more often on angiotensin-converting enzyme inhibitor (37% vs 25%, p= 0.03) than women with TA. There was no difference in mean cholesterol level, CAD severity or body mass index between the two groups. Over a median of 8.8 years, 122 (34%) women died including 92 NTA and 30 TA (HR 1.5, 95% CI 1.006, 2.30) (Figure). Conclusions: Among WISE women with signs and symptoms of ischemia and obstructive CAD, NTA has a higher mortality compared to TA. These findings extend prior evidence that chest pain, including NTA, identifies higher risk in women with obstructive CAD. These data support intensive management and clinical follow up of women with obstructive CAD and NTA. Further evaluation regarding ischemic burden and treatment is ongoing to further understand the elevated NTA mortality.
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