Abstract 47: Presentation and Outcomes of Women Veterans with Suspected Ischemia and Nonobstructive Coronary Artery Disease: Insights from the VA Clinical Assessment Reporting and Tracking Program.

Abstract

Background: Chest pain in the presence of non-obstructive coronary artery disease (CAD) is a common clinical scenario. Prior non-VA studies have shown that symptomatic women with non-obstructive coronary disease have a high rate of re-hospitalization for chest pain, and are at increased risk for cardiovascular events. To date, the presentation and outcomes of women veterans with non-obstructive CAD is unknown. Methods: Using data from the VA Clinical Assessment Reporting and Tracking (CART) Program, a national clinical quality program that collects data on coronary procedures performed in the VA, we analyzed clinical characteristics between men and women veterans who presented for initial cardiac catheterization due to suspected ischemia between 10/1/2007 and 9/30/2011, and were found to have angiographically non-obstructive CAD. In addition, rates of death, stroke, and readmission for chest pain among women were calculated and presented. Suspected ischemia was defined by an angiogram indication of chest pain, acute coronary syndrome or a positive functional study. Non-obstructive CAD was defined at the time of catheterization by the primary operator. Results: Overall, 53,806 patients underwent coronary angiography in this period, of which 3.4% (1848 of 53,806) were women .There were 9608 (18.5%, 9608 of 51,958) men and 429 (23.2%, 429 of 1848) women who underwent angiography for suspected ischemia had non-obstructive CAD. Compared to men, women veterans were significantly younger (56.9 vs 61.9 yrs p <0.0001), had more depression (49.0%, 210 of 429 vs 32.5%, 3118 of 9608, p< 0.001), and obesity (56.2% 241 of 429 vs 45.1% 4335 of 9608, p<0.001). Women veterans had less hypertension (82.8%, 355 of 429 vs 86.3% 8287 of 9608, p=0.04), diabetes (33.6%, 144 of 429 vs 38.8% 3731 of 9608, p=0.03), and peripheral vascular disease (7.0% 30 of 429 vs 12.0% 1155 of 9608, p=0.002). Over a median follow up of 21 months, death occurred in 1.2% (5/429) women, stroke in 3.7% (16 of 429), and hospital readmission for chest pain in 1.9% (8 of 429). Conclusion: Between October 2007 and September 2011, 23% of women veterans undergoing catheterization for suspected ischemia had non-obstructive CAD. In contrast to non-VA studies, adverse clinical outcomes and re-hospitalization rates for chest pain were less frequent. These findings may represent systematic differences in treatment and follow-up care of women veterans between VA and non-VA healthcare systems.