Sex differences in the evaluation and outcomes of multi-ethnic asian patients undergoing stress echocardiography

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Stress echocardiography is an important test used in the evaluation of myocardial ischemia. Despite this, not much is known about sex differences between men and women undergoing stress echocardiography, with regards to their characteristics and outcomes, especially in the Asian population. Methods We performed a retrospective cohort study of 1504 consecutive patients evaluated with dobutamine or exercise stress echocardiography performed for suspected coronary artery disease (CAD) or to evaluate the status of known CAD. We divided the patients into two groups: males and females. The tests were classified as positive, equivocal, or negative for ischemia, and the outcomes at 6 months follow-up was analysed. Results 48.1% (723) patients were males. The mean age of patients was 52.2 ± 14.9 years for males and 55.8 ± 12.5 years for females. The 3 most common indications for stress echocardiography in both males and females were for the assessment of symptoms for suspected CAD in 787 (52.3%), for the assessment of a prior abnormal test in 408 (27.1%) and for the assessment of the status of pre-existing CAD in 93 (6.2%). In terms of co-morbidities, males were more likely to have ischemic heart disease (<0.001), prior AMI (p<0.001), prior PCI (p<0.001) and CABG (p=0.002). Stress echocardiography was normal in 608 men (84.3%) and 643 women (82.3%). A positive result on stress echocardiography was obtained in 65 men (9.0%) and 63 women (8.1%), and equivocal result in 48 men (6.7%) and 75 women (9.6%). During a mean follow-up of 7.9 ± 0.2 years, 84 men (11.6%) and 44 women (5.6%) (p<0.001) experienced a cardiac event, of which there were 40 (2.7%) deaths, with 26 men (3.6%) and 14 women (1.8%) (p=0.030). 26 men (3.6%) and 6 women (0.8%) (p<0.001) experienced an acute myocardial infarction. Independent predictors of cardiac events in patients using a Cox proportional hazards regression analysis were age (hazard ratio (HR): 1.05 [range 1.03 to 1.07]), female gender (HR: 0.50 [range: 0.328 to 0.760]) and previous myocardial infarction (HR: 2.50 [range 1.28 to 4.86]) Conclusion Differences in mean age, prevalence of ischemic heart disease, prior myocardial infarction and prior PCI/CABG were noted between males and females who underwent stress echocardiography. Males experienced a higher incidence of cardiac events compared to females. Gender is an independent predictor of cardiac events in patients undergoing stress echocardiography, together with age and a history of myocardial infarction.