Chest Pain Registry Research Articles

Association between the number of pregnancies and cardiac target organ damages: a cross-sectional analysis of data from the Korean women’s chest pain registry (KoROSE)

BackgroundPregnancy increases long-term cardiovascular risk after childbirth, but the mechanisms are unclear. This study was performed to investigate the association between the number of pregnancies and several cardiac target organ damage (TOD) in middle-aged and elderly women.MethodsUsing the database of the nation-wide registry, a total of 1,137 women (mean age 63.0 ± 10.9 years) with stable chest pain undergoing invasive coronary angiography (CAG) were analyzed. Information on the number of pregnancies was obtained through a questionnaire. Obstructive coronary artery disease (CAD), left ventricular (LV) mass index (LVMI) and LV septal annular (e′) velocity were assessed as indicators of cardiac TOD.ResultsWomen with higher number of pregnancies (≥ 3) were older (66.3 ± 9.6 vs. 57.4 ± 10.7 years; P < 0.001), had more cardiovascular risk factors, and took more cardiovascular medications than those with lower number of pregnancies (< 3). In multivariable analyses, higher number of pregnancies (≥ 3) was associated with obstructive CAD (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.21–2.17; P = 0.001), a higher LVMI (> 95 g/m2) (OR, 1.46; 95% CI, 1.08–1.98; P = 0.013) and a lower septal e′ velocity (< 7 cm/s) (OR, 1.55; 95% CI, 1.12–2.14; P = 0.007) even after controlling for potential confounders. As the number of pregnancies increased, the prevalence of CAD and LVMI increased, and the septal e’ velocity gradually decreased (P < 0.001 for each).ConclusionsIn women with chest pain undergoing invasive CAG, higher number of pregnancies was associated with multiple cardiac TOD. Parity information should be checked when assessing a woman’s cardiovascular risk.

Sex Differences in Coronary Artery Disease: Insights From the KoRean wOmen'S chest pain rEgistry (KoROSE).

Interest in sex differences in coronary artery disease (CAD) has been steadily increasing. Concurrently, most of the data on these differences have primarily been Western-oriented. The KoRean wOmen'S chest pain rEgistry (KoROSE), started in 2011, has since published numerous research findings. This review aims to summarize the reported differences between men and women in CAD, integrating data from KoROSE. Cardiovascular risk in postmenopausal women escalates dramatically due to the decrease in estrogen levels, which normally offer cardiovascular protective effects. Lower estrogen levels can lead to abdominal obesity, insulin resistance, increased blood pressure, and endothelial dysfunction in older women. Upon analyzing patients with CAD, women are typically older and exhibit more cardiovascular risk factors than men. Diagnosing CAD in women tends to be delayed due to their symptoms being more atypical than men's. While in-hospital outcome was similar between sexes, bleeding complications after percutaneous coronary intervention occur more frequently in women. The differences in long-term prognosis for CAD patients between men and women are still a subject of ongoing debate. Pregnancy and reproductive factors also play a significant role as risk factors for cardiovascular disease in women. A notable sex disparity exists, with women found to use fewer cardiovascular protective drugs and undergo fewer interventional or surgical procedures than men. Additionally, women participate less frequently than men in clinical research. Through concerted efforts to increase awareness of sex differences and mitigate sex disparity, personalized treatment can be provided. This approach can ultimately improve patient prognosis.

Sex differences in coronary angiographic findings in patients with stable chest pain: analysis of data from the KoRean wOmen\u2019S chest pain rEgistry (KoROSE)

BackgroundFocused evaluations on potential sex differences in the angiographic findings of the coronary arteries are scarce. This study was performed to compare the angiographic extent and localization of coronary stenosis between men and women.MethodsA total of 2348 patients (mean age 62.5 years and 60% women) with stable chest pain undergoing invasive coronary angiography (CAG) were recruited from the database of the nation-wide chest pain registry. Obstructive coronary artery disease (CAD) was defined as ≥ 50% stenosis of the left main coronary artery and/or ≥ 70% stenosis of any other epicardial coronary arteries.ResultsAlthough women were older than men (64.4 ± 10.3 vs. 59.5 ± 11.4 years, P < 0.001), men had worse risk profiles including high blood pressure, more frequent smoking and elevated triglyceride and C-reactive protein. The prevalence of obstructive CAD was significantly higher in men than in women (37.0% vs. 28.4%, P < 0.001). Men had a higher prevalence of LM disease (10.3% vs. 3.5%, P < 0.001) and three-vessel disease (16.1% vs. 9.5%, P = 0.007) compared to women. In multiple binary logistic regression analysis, the risk of men having LM disease or three-vessel disease was 7.4 (95% confidence interval 3.48–15.97; P < 0.001) and 2.7 (95% confidence interval 1.57–4.64; P < 0.001) times that of women, respectively, even after controlling for potential confounders.ConclusionsIn patients with chest pain undergoing invasive CAG, men had higher obstructive CAD prevalence and more high-risk angiographic findings such as LM disease or three-vessel disease.

Coronary Calcium to Rule Out Obstructive Coronary Artery Disease in Patients With Acute Chest Pain

ObjectivesThis study aimed to evaluate the ability of coronary artery calcium (CAC) as an initial diagnostic tool to rule out obstructive coronary artery disease (CAD) in a very large registry of patients presenting to the emergency department (ED) with acute chest pain (CP) who were at low to intermediate risk for acute coronary syndrome (ACS). BackgroundIt is not yet well established whether CAC can be used to rule out obstructive CAD in the ED setting. MethodsWe included patients from the Baptist Health South Florida Chest Pain Registry presenting to the ED with CP at low to intermediate risk for ACS (Thrombolysis In Myocardial Infarction risk score ≤2, normal/nondiagnostic electrocardiography, and troponin levels) who underwent CAC and coronary computed tomography angiography (CCTA) procedures for evaluation of ACS. To assess the diagnostic accuracy of CAC testing to diagnose obstructive CAD and identify the need for coronary revascularization during hospitalization, we estimated sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV). ResultsOur study included 5,192 patients (mean age: 53.5 ± 10.8 years; 46% male; 62% Hispanic). Overall, 2,902 patients (56%) had CAC = 0, of which 135 (4.6%) had CAD (114 [3.9%] nonobstructive and 21 [0.7%] obstructive). Among those with CAC >0, 23% had obstructive CAD. Sensitivity, specificity, PPV, and NPV of CAC testing to diagnose obstructive CAD were 96.2%, 62.4%, 22.4%, and 99.3%, respectively. The NPV for identifying those who needed revascularization was 99.6%. Among patients with CAC = 0, 11 patients (0.4%) underwent revascularization, and the number needed to test with CCTA to detect 1 patient who required revascularization was 264. ConclusionsIn a large population presenting to ED with CP at low to intermediate risk, CAC = 0 was common. CAC = 0 ruled out obstructive CAD and revascularization in more than 99% of the patients, and <5% with CAC = 0 had any CAD. Integrating CAC testing very early in CP evaluation may be effective in appropriate triage of patients by identifying individuals who can safely defer additional testing and more invasive procedures.

Baseline thrombocytopenia in acute coronary syndrome: The lower, the worse

BackgroundPatients with baseline thrombocytopenia can have increased mortality and morbidity, but are typically excluded from randomized clinical trials studying acute coronary syndromes (ACS). We sought to better define the effect thrombocytopenia on clinical outcomes in ACS patients. MethodsPatients identified from the NCDR Chest Pain registry at Mayo Clinic Arizona from Oct 2015 to Sep 2018 were retrospectively classified into two groups: TP (platelet <150 × 103 μL) and control (platelet ≥150 × 103 μL). The groups were analyzed for the clinical outcome (all-cause mortality, major adverse cardiac events (MACE), and bleeding events). The TP group was divided into moderate-severe thrombocytopenia (TPmod; platelet 50–100 × 103 μL) and mild thrombocytopenia (TPmild; platelet 100–150 × 103 μL) for further analysis. P-value <0.05 is considered significant. ResultsFive hundred and thirty-six patients were identified, and 72 patients (13%) had thrombocytopenia. The median follow-up time was 1.1 years. The TP group was older (TP vs. control: mean age 73 ± 13 years vs. 70 ± 13 years; P = 0.026). In patients discharged on dual-antiplatelet therapy, the TP group had higher all-cause mortality (23% vs. 7.3%; P = 0.007) but not major bleeding events (11% vs. 5.0%; P = 0.123). Only all-cause mortality increased with the severity of thrombocytopenia (TPmod vs. TPmild vs. control: 33% vs. 24% vs. 7.3%; P = 0.007). ConclusionsIn patients with ACS, baseline thrombocytopenia is associated with increased all-cause mortality and all bleeding events without net MACE benefit. Further study is needed to identify the optimal antiplatelet strategy in this higher risk population.

Sex Difference in the Association Between Metabolic Syndrome and Obstructive Coronary Artery Disease: Analysis of Data from the KoRean wOmen'S chest pain rEgistry (KoROSE).

Background: The sex-related impact of metabolic syndrome (MetS) on obstructive coronary artery disease (OCAD) has not been well evaluated. Methods: A total of 1156 patients (62 years and 58% women) with chest pain undergoing invasive coronary angiography (CAG) were recruited from the database of the nation-wide chest pain registry. MetS was defined according to the criteria of the International Diabetes Federation. OCAD was defined as ≥50% stenosis of the left main coronary artery and/or ≥70% stenosis of any other coronary arteries. Results: Women were older than men (65 vs. 59 years, p < 0.001). OCAD (32.0% vs. 30.9%) and MetS (27.8% vs. 27.9%) prevalence rates were similar in both sexes (p > 0.05). The presence of MetS was associated with higher prevalence of OCAD in women (24.5% vs. 47.3%, p < 0.001), but not in men (31.0% vs. 34.3%, p = 0.487). The linear association between the number of components meeting MetS criteria and OCAD prevalence was significant in both sexes (p < 0.001 for each), but it was stronger in women than in men (Chi-square value: 81.9 vs. 14.8, p < 0.001). In a multivariable model, the presence of MetS was independently associated with OCAD in women even after controlling for potential confounders (odds ratio, 1.92; 95% confidence interval, 1.31-2.81; p = 0.001). Conclusions: In patients with chest pain undergoing invasive CAG, the association between the number of components meeting MetS criteria and OCAD prevalence was stronger in women than in men.

The disutility of stress testing in low-risk HEART Pathway patients.

The HEART Pathway identifies low-risk chest pain patients for discharge from the Emergency Department without stress testing. However, HEART Pathway recommendations are not always followed. The objective of this study is to determine the frequency and diagnostic yield of stress testing among low-risk patients. An academic hospital's chest pain registry was analyzed for low-risk HEART Pathway patients (HEAR score≤3 with non-elevated troponins) from 1/2017 to 7/2018. Stress tests were reviewed for inducible ischemia. Diagnostic yield was defined as the rate of obstructive CAD among patients with positive stress testing. T-test or Fisher's exact test was used to test the univariate association of age, sex, race/ethnicity, and HEAR score with stress testing. Multivariate logistic regression was used to determine the association of age, sex, race/ethnicity, and HEAR score with stress testing. There were 4743 HEART Pathway assessments, with 43.7% (2074/4743) being low-risk. Stress testing was performed on 4.1% (84/2074). Of the 84 low-risk patients who underwent testing, 8.3% (7/84) had non-diagnostic studies and 2.6% (2/84) had positive studies. Among the 2 patients with positive studies, angiography revealed that 1 had widely patent coronary arteries and the other had multivessel obstructive coronary artery disease, making the diagnostic yield of stress testing 1.2% (1/84). Each one-point increase in HEAR score (aOR 2.17, 95% CI 1.45-3.24) and being male (aOR 1.59, 95% CI 1.02-2.49) were associated with testing. Stress testing among low-risk HEART Pathway patients was uncommon, low yield, and more likely in males and those with a higher HEAR score.

Sex differences of the association between marital status and coronary artery disease in patients experiencing chest pain: The Korean Women's Chest Pain Registry.

Marriage is an important social practice that predicts various health outcomes, including those of cardiovascular disease. This study investigated the sex-specific association between marital status and coronary artery disease (CAD) in patients experiencing chest pain. Study data were obtained from a nationwide registry of patients with suspected CAD who underwent coronary angiography. We dichotomized all participants according to marital status as follows: without a spouse (single, divorced, or widowed), and with a spouse. Significant CAD was defined as greater than 50% narrowing of the lumen diameter in any of the coronary arteries. The presence of significant CAD was significantly higher in female participants without a spouse than in female participants with a spouse. However, there was no significant difference in the presence of CAD in men between the two groups. Interestingly, there was also no significant difference in the presence of CAD between women without a spouse and men without a spouse. After adjustment for all possible confounding factors, women without a spouse had a 1.62-fold increased hazard for significant CAD in multivariate regression analysis. In contrast to men, a without spouse status is independently associated with significant CAD in women experiencing chest pain. Women with a spouse had the lowest presence of CAD among all groups. In the management of female patients experiencing chest pain, clinicians should consider their social characteristics, including marital status, to predict subsequent cardiovascular disease and determine the appropriate treatment. : Video Summary:http://links.lww.com/MENO/A567.

Abstract TP314: Baseline Thrombocytopenia in Patients With Acute Coronary Syndrome: Does it Affect Following Cerebrovascular Event Rates?

Introduction: Baseline thrombocytopenia (TP) is a common condition in patients with acute coronary syndrome (ACS) and acute ischemic stroke and has been shown to increase mortality. The effect of baseline TP on cerebrovascular events following initial ACS event is not well studied. Methods: We retrospectively reviewed all patients identified from the institutional NCDR Chest Pain registry database at Mayo Clinic Arizona from Oct 2015 to Sep 2018. Patients were classified into TP (platelet &lt;150) and control (platelet &gt; 150) groups for clinical outcome (stroke/TIA and bleeding events) analysis. P-value &lt; 0.05 is considered significant. Results: Five hundred and thirty-six patients were included for final analysis. Patient demographics and clinical outcomes are shown in Table 1. The rates of dual antiplatelet therapy (DAPT) prescription at discharge (TP vs. control: 68.1% and 75.4%, P=0.197), stroke/TIA (1.3% vs. 2.4%, P=1.000) and recurrent myocardial infarction (11.1% vs. 11.2%, P=1.000) were similar between the two groups. The TP group has more bleeding events compared to control (Figure 1). Conclusions: In patients with ACS, baseline TP does not affect stroke/TIA events but is associated with higher bleeding rate. The results could not be explained by the DAPT or anticoagulation use alone. Further studies are needed to investigate the pathophysiologic correlation of thrombocytopenia, DAPT, and stroke in ACS patients.

Association between obesity type and obstructive coronary artery disease in stable symptomatic postmenopausal women: data from the KoRean wOmen'S chest pain rEgistry (KoROSE).

This study investigated the association between obesity type and obstructive coronary artery disease (CAD) in postmenopausal women. Study data were obtained from a nation-wide registry, composed of 659 women older than 55 years with chest pain undergoing elective invasive coronary angiography in the suspicion of CAD. Obstructive CAD was defined as angiographic findings of ≥50% diameter stenosis with any major epicardial coronary artery. Overall obesity was defined as a body mass index of ≥25 kg/m, and central obesity was defined as a waist circumference of ≥85 cm. A total of 311 women (47.2%) had obstructive CAD. The incidence of overall obesity was not different between participants with and without obstructive CAD (P = 0.340), but the prevalence of obstructive CAD was significantly higher in participants with central obesity than those without (55.5% vs 41.0%, P < 0.001). There was no significant difference in body mass index between participants with and without obstructive CAD (P = 0.373). Multivariable analysis showed that central obesity was associated with obstructive CAD even after controlling for potential confounders (odds ratio, 1.61; 95% confidence interval, 1.10-2.34; P = 0.013). However, overall obesity was not associated with obstructive CAD in the same multivariable analysis (P = 0.228). Central obesity but not overall obesity is associated with obstructive CAD in postmenopausal women with stable chest pain undergoing invasive coronary angiography. : Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A440.

Gender differences in the presentation of chest pain in obstructive coronary artery disease: results from the Korean Women's Chest Pain Registry.

Background/AimsChest pain in patients with obstructive coronary artery disease (OCAD) is affected by several social factors. The gender-based differences in chest pain among Koreans have yet to be investigated.MethodsThe study consecutively enrolled 1,549 patients (male/female, 514/1,035; 61 ± 11 years old) with suspected angina. The predictive factors for OCAD based on gender were evaluated.ResultsMen experienced more squeezing type pain on the left side of chest, while women demonstrated more dull quality pain in the retrosternal and epigastric area. After adjustment for risk factors, pain in the retrosternal area (odds ratio [OR], 1.491; 95% confidence interval [CI], 1.178 to 1.887) and aggravation by exercise (OR, 2.235; 95% CI, 1.745 to 2.861) were positively associated with OCAD. In men, shorter duration (OR, 1.581; 95% CI, 1.086 to 2.303) and dyspnea (OR, 1.610; 95% CI, 1.040 to 2.490) increased the probability for OCAD, while left-sided chest pain suggested a low probability for OCAD (OR, 0.590; 95% CI, 0.388 to 0.897). In women, aggravation by emotional stress (OR, 0.348; 95% CI, 0.162 to 0.746) and dizziness (OR, 0.457; 95% CI, 0.246 to 0.849) decreased the probability for OCAD.ConclusionsThis is the first study to focus on gender differences in chest pain among Koreans with angina. Symptoms with high probability for OCAD were different between sexes. Our findings suggest that patient’s medical history in pretest assessment for OCAD should be individualized considering gender.

Sex Differences in the Relationship Between Left Ventricular Diastolic Dysfunction and Coronary Artery Disease: From the Korean Women's Chest Pain Registry.

Although coronary artery disease (CAD) is an important comorbidity, the influence of CAD on left ventricular diastolic dysfunction (LVDD) is not clear. This study aims to assess differences in the relationship between CAD and LVDD according to sex and comorbidities. A total of 1109 consecutive patients who visited an outpatient clinic with chest pain were included. The outcomes in 295 men and 295 women were compared after propensity score 1:1 matching. The evaluation of LVDD was based on guidelines recommended by the American Society of Echocardiography. The presence and severity of obstructive CAD was assessed by coronary angiography. After propensity score matching, both men and women were well balanced, with no significant differences of baseline covariates. Differences in diastolic functional parameters according to CAD severity were observed only in women (three parameters of LVDD except e' velocity, p < 0.05). Multiple logistic regression for matched pair data demonstrated that CAD severity was associated with the presence of LVDD only in women (odds ratio 1.919, 95% confidence interval 1.343-2.741, p < 0.001). Interaction between sex and severity of CAD was significant (p = 0.025). The association of LVDD and CAD severity was observed only in women. Myocardial ischemia may be a potential pathophysiology for higher prevalence of LVDD and heart failure with preserved ejection fraction in women.

Association of epicardial adipose tissue with coronary spasm and coronary atherosclerosis in patients with chest pain: analysis of data collated by the KoRean wOmen'S chest pain rEgistry (koROSE).

Epicardial adipose tissue (EAT) represents a cardio-metabolic risk factor; it secretes several adipokines related to coronary atherosclerosis. However, the precise relationship between EAT and coronary vasospasm is unknown. This study aimed to investigate the relationship between EAT and coronary vasospasm using data from the KoRean wOmen'S chest pain rEgistry (koROSE). This study included 551 patients (female/male=366/185; mean age=60.2±10.2years) who presented with chest pain at an outpatient clinic, and who subsequently underwent echocardiography and coronary angiography. Coronary artery stenosis (CAS >50% narrowing of at least one coronary artery) was detected in 223 patients (40.5%). The remaining 328 patients underwent the coronary spasm provocation test. Coronary spasm was defined as >90% narrowing induced by intra-coronary acetylcholine or ergonovine injection. EAT thickness was measured using transthoracic echocardiography according to American society of echocardiography recommendations. The mean EAT thickness was higher in the patients with CAS than in those without (8.09±2.51 versus 6.88±2.54 mm, P=0.001) after adjusting for factors potentially influencing EAT thickness. Coronary vasospasm by provocation test was detected in 128 patients. The EAT thickness was higher in the patients with spasm than in those without (7.65±2.52 versus 6.40±2.45 mm, P<0.001) but was not statistically different from that of the patients with CAS (P=0.43). The EAT thickness had an independent relationship with CAS [odds ratio (OR) 1.166, 95% confidence interval (CI) 1.07-1.27, P<0.001] and coronary vasospasm [OR 1.276, 95% CI 1.14-1.43, P<0.001] after adjusting for clinical cardiovascular risk factors. EAT thickness is associated with coronary vasospasm and coronary atherosclerosis. The pathophysiology of coronary spasm may be similar to that of coronary atherosclerosis and could be an indicator of coronary stenosis.

P2436Sex difference in the association of left ventricular diastolic function with coronary artery disease: from the Korean women's chest pain registry (KoROSE)

P2436Sex difference in the association of left ventricular diastolic function with coronary artery disease: from the Korean women's chest pain registry (KoROSE)

PS 14-08 RELATION OF IMPAIRED HEART RATE RECOVERY AND LEFT VENTRICULAR DIASTOLIC FUNCTION IN HYPERTENSIVE PATIENTS

Objective: It has been reported that the cardiovascular autonomic neuropathy (CAN) is present in patients with heart failure. But the relation between CAN and left ventricular (LV) diastolic function in asymptomatic patients has not been clearly elucidated. The aim of this study was to evaluate the relationship between CAN and LV diastolic function in asymptomatic hypertensive patients. Design and Method: 98 patients (F/M = 74/24, mean age = 57.3 ± 9 years old) from the KoRean wOmen'S chest pain rEgistry (KoROSE) study with hypertension were enrolled. All patients underwent TET and echocardiography. Autonomic dysfunction were evaluated by heart rate recovery (HRR: Maximal HR during exercise-HR at 3minute after exercise termination) and blood pressure response (BPR: SBP at 3minute after exercise termination / Maximal SBP during exercise). The definition of left ventricular hypertrophy was defined as >115 g/m2 for male and >95 g/m2 for female. Patients with mitral annular tissue velocity (e’)<8 cm/sec were categorized as patients with diastolic dysfunction (DD). Results: The patient with DD was 76 patients (77.6%). Exercise capacity was decreased in hypertensive patients with DD (10.0 ± 2.8 vs 11.6 ± 2.4 METs, P = 0.017). We divided the patients into 4 groups as hypertension only (n = 19), hypertension with LVH (n = 3), hypertension with DD (n = 46) and hypertension with LVH and presence of DD (n = 30). HRR and BPR were progressively impaired according to the presence of LVH and DD (Table 1). Conclusions: In hypertensive patients, the presence of DD was associated with cardiac autonomic dysfunction and was related with diminished exercise tolerance even in asymptomatic patients.

OS 23-05 LEFT VENTRICULAR HYPERTROPHY AND SIGNIFICANT CORONARY ARTERIAL STENOSIS INTERACTION IN HYPERTENSIVE WOMEN

Objective: Left ventricular hypertrophy (LVH) and coronary atherosclerosis are common cardiac complications of hypertension. Previous studies have shown that LVH is associated with increased cardiovascular mortality, regardless of coronary artery disease. The purpose of this study was to evaluate the relationship between LVH and significant coronary arterial stenosis in hypertensive women with chest pain. Design and Method: One hundred ninety four hypertensive women with eligible data from the Korean women's chest pain registry (KoROSE) study were included. We analyzed echocardiographic data, demographic information, risk factors for cardiovascular disease, medical history, medication, and biochemical data. Patients with history of arrhythmia or significant valvular heart disease were excluded. LVH was defined if left ventricular mass index (LVMI) normalized by body surface area was more than 95 g/m2. Significant coronary arterial stenosis was defined as ≥50% luminal obstruction at least in one major epicardial coronary artery. Results: LVH group (n = 108) showed higher prevalence of significant coronary arterial stenosis compared with group without LVH (n = 86) (67.1% vs. 50.0%, p = 0.035). Body weight, height, blood pressure (BP), and lipid profile and hematologic findings were not significantly different between two groups. Total duration of exercise and the amount of work were not significantly different between two groups. However, LVH group showed higher diastolic BP at peak exercise in treadmill exercise test (85.4 mmHg vs. 77.1 mmHg, p = 0.003). Left ventricular ejection fraction (LVEF) was lower and parameters of diastolic function such as left atrial size were distorted in LVH group (p < 0.05). LVMI was correlated with LVEF and diastolic parameter. LVH was a predictor of significant coronary arterial stenosis (Odds ratio 2.037, 95% confidence interval = 1.066–3.894). Conclusions: LVH defined by LVMI is associated with higher prevalence of significant coronary arterial stenosis in hypertensive women with chest pain.

Sex Difference in the Association Between Brachial Pulse Pressure and Coronary Artery Disease: The Korean Women's Chest Pain Registry (KoROSE).

This study was performed to investigate the association between brachial pulse pressure (PP) and the presence/extent of obstructive coronary artery disease (CAD) in men and women. Study data were obtained from a nation-wide registry composed of 632 patients (173 men and 459 women, 58.1±10.5 years) with suspected CAD who underwent invasive coronary angiography. PP was higher in patients with obstructive CAD (≥50% stenosis) than those without CAD in both sexes (P=.032 in men; P<.001 in women). However, PP increased proportionally with the increasing number of obstructed coronary arteries in women (P<.001) but not in men (P=.070). Multiple logistic-regression analyses demonstrated that higher PP (≥50.5 mm Hg) was an independent factor for determining obstructive CAD even after controlling for potential confounders in women (odds ratio, 2.83; 95% confidence interval, 1.40-5.73; P=.004). These results were consistent in 173 selected women matched with 173 men based on age and CAD severity. In conclusion, the association between brachial PP and obstructive CAD was more pronounced in women than in men. Brachial PP can be a simple and useful indicator of CAD especially in women.

49 The use of CT coronary angiography following exercise stress testing in a low risk population presenting to a chest pain service

Background Exercise Stress Testing (EST) is commonly used as a non-invasive diagnostic investigation to detect obstructive Coronary Artery Disease (CAD) in low risk chest pain populations, in addition to assessing functional capacity of patients with known CAD. Computerised Tomography Coronary Angiograms (CTCAs) are indicated for continuing symptoms despite a negative EST. Purpose To look at the overall rate of obstructive Coronary Artery disease in patients referred to the Chest Pain Service, to look at the current use of EST as a preliminary investigation, and to compare results of patients’ ESTs with any subsequent CTCAs. Method We used the hospital’s chest pain registry, which contains data on all patients referred through the Chest Pain Service, and selected all patients presenting initially between 1/1/12 and 31/7/14. Patients were classified initially by the GRACE risk tool. We obtained EST results from the electronic patient record, and CTCA results from the Hospital’s Radiology System. Results 1211 patients were referred to the Chest Pain Service for Investigation of Chest Pain over 31 months (Data available on 1200); 1101 Low Risk (91.8%), 93 Intermediate Risk 93 (7.8%), and 6 High Risk (0.5%). 27 patients were referred twice during the study period. 1038 patients were referred for EST; 686 (66.1%) of the ESTs were negative, 177 (17.1%) were inconclusive, 172 (16.6%) were positive, and 3 not specified. The 132 patients who, after EST, were referred for CTCA, had a higher risk of having Obstructive CAD if they were referred after a negative EST (23.8%), than compared with an inconclusive (11.2%) or positive (19.6%) EST. Despite 86.5% of Chest Pain service patients being referred for EST as an initial investigation; 36.9% of these underwent subsequent Coronary Imaging (132 CTCAs and 251 Coronary Angiograms). 17.4% of the overall Chest Pain Service population had obstructive Coronary Artery disease. Conclusion A higher clinical suspicion is required to refer for CTCA (or Invasive Coronary Angiography) after a negative EST, than for an inconclusive or positive EST. Our data showed that the clinical suspicion carries more weight than EST result, with higher rates of Obstructive CAD for CTCAs after negative ESTs, then compared with Inconclusive or Positive results. The decision to proceed with CTCA despite a normal EST can be justified on clinical features.

Is there any gender difference in coronary angiography of chest pain in women? From the Korean women's chest pain registry (KOROSE)

Is there any gender difference in coronary angiography of chest pain in women? From the Korean women's chest pain registry (KOROSE)

THE PREDICTOR OF CORONARY VASOSPASM IN THE WOMEN PATIENTS WITH CHEST PAIN: FROM THE KOREAN WOMEN’S CHEST PAIN REGISTRY (KOROSE) STUDY

Coronary artery vasospasm is a frequent pathophysiology of angina in women. However, the predictor of the coronary spasm was not well established in the women patients. The purpose of this study was to evaluate the risk factors of coronary spasm from the KoRean wOmen’S chest pain rEgistry (KoROSE