Abstract 13064: Sex-Related Differences in Chest Pain and Asymptomatic Myocardial Ischemia Experienced During Exercise Stress Echocardiogram

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Background: Coronary artery disease (CAD) continues to account for significant morbidity and mortality for both men and women. Women present with greater variability in symptoms from coronary artery disease than men. This study seeks to describe the potential differences between men and women in the association between stress test-related chest pain and obstructive CAD. Methods: Patients with an exercise stress test who underwent a coronary angiogram from September 2013 to January 2019 were included in our analyses. The patients’ clinical characteristics, symptoms, coronary angiography and ECGs were analyzed to determine the relationship between ischemia, chest pain, and obstructive coronary artery disease (CAD; stenosis > 70%). T-tests and chi-square tests described differences in continuous and categorical variables, respectively. Logistic regression was used to adjust for demographic, imaging, and stress testing factors. Results: A total of 368 patients were included in our analyses: 297 patients had a positive stress echocardiogram or ECG; 71 patients had negative stress tests but continued to have persistent symptoms. The study population had a mean age of 63 years and included 29% female, 11% African-American, and 61% obstructive CAD. In those with obstructive CAD, only 39% of women experienced chest pain during stress (p>0.2), but in men, 48% experienced stress test related chest pain (p<0.001). Adjusting for baseline demographics in sex-stratified models, echo-based ischemia and ECG-based ischemia were significantly associated with obstructive CAD in women, but stress-test related chest pain was not (p=0.02; p<0.001; p>0.2, respectively). In men, echo-based ischemia, ECG-based ischemia, and stress-test related chest pain all associated with obstructive CAD (p<0.001; p<0.001; p=0.008, respectively). These changes persisted with adjustment for stress test performance (METS, heart rate achieved) as well as baseline left ventricular ejection fraction. Conclusion: In women, stress test-related chest pain during stress testing was not associated with obstructive CAD. Further studies are needed to understand the role, significance, and management of potential myocardial ischemia without chest pain in women.