Coronary Angiography In Women Research Articles

Comparative effectiveness of initial computed tomography and invasive coronary angiography in women and men with stable chest pain and suspected coronary artery disease: multicentre randomised trial

ObjectiveTo assess the comparative effectiveness of computed tomography and invasive coronary angiography in women and men with stable chest pain suspected to be caused by coronary artery disease.DesignProspective, multicentre, randomised...

ХАРАКТЕРИСТИКА МОРФО-ФУНКЦІОНАЛЬНОГО СТАНУ КОРОНАРНОГО КРОВООБІГУ В ПЕРИМЕНОПАУЗАЛЬНИХ ЖІНОК, ГОСПІТАЛІЗОВАНИХ З ПРИВОДУ ГОСТРОГО КОРОНАРНОГО СИНДРОМУ БЕЗ ПІДЙОМУ СЕГМЕНТА ST.

Особливу увагу кардіологи та науковці надають жінкам із гострим коронарним синдромом (ГКС) перименопаузального віку. Завдяки дії естрогенів, жінки протягом репродуктивного періоду мають нижчий ризик розвитку гострої коронарної патології, кардіоваскулярне протективне значення яких втрачається унаслідок істотного зниження естрогенового фону в перименопаузальний період.Мета дослідження – провести порівняльний аналіз стану вінцевого кровообігу за даними коронарної ангіографії у жінок із гострим коронарним синдромом без підйому сегмента ST (ГКСбпST) залежно від рівня статевих гормонів.Матеріали і методи. Обстежено 81 жінку віком 35–76 років (середній вік (59,1±1,06) року, яких госпіталізовано з приводу ГКСбпST і визначали рівень жіночих статевих гормонів (естрадіол, ЛГ (лютеїнізуючий гормон), ФСГ (фолікулостимулювальний гормон гіпофіза) та проводили коронароангіографію. Залежно від гормонального статусу всіх пацієнток загальної групи поділили на дві підгрупи: І підгрупа (n=50) – жінки з індексом співвідношення рівня ЛГ/ФСГ<1 (естрогенодефіцит). У ІІ підгрупу (n=31) увійшли хворі жінки з індексом ЛГ/ФСГ>1 (відносно збережений естрогеновий фон).Результати досліджень та їх обговорення. Порівняно з жінками, які мають відносно збережений естрогеновий фон (ІІ підгрупа), у жінок з естрогенодефіцитом (І підгрупа) достовірно частіше реєструються тяжкі гемодинамічно значимі ураження коронарних артерій, а саме: у 6 разів частіші багатосудинні ураження (35,14 % (І) проти 5,88 % (ІІ)), у 2–2,8 раза частіше з локалізацією переважно в проксимальних (81,08 % (І) та 29,41 % (ІІ)) медіальних сегментах 70,83 % (І) та 35,29 % (ІІ)), майже у половини – у поєднанні з ураженнями дистальних сегментів (48,65 % (І) проти 17,65 % (ІІ)). Найчастіше виявляються зміни в основних магістральних артеріях – лівій коронарній артерії та її передній міжшлуночковій гілці. У двох із трьох жінок з ГКСбпST загальної групи (55 хворих, 67,90 %) відмічено непрямі ознаки істотних порушень коронарної мікроциркуляції та міокардіальної перфузії, які у півтора раза достовірно частіше реєструвалися в осіб з ознаками гіпоестрогенії в постменопаузальному періоді. У третини обстежених жінок (33,33 %) загальної групи при коронароангіографії виявляли практично інтактні коронарні артерії. У жінок з гемодинамічно значимими стенозами візуалізувались дефекти (звиразкування) атеросклеротичних бляшок. Індекс виразкування, який в загальній групі становив (0,770±0,012) од., виявився достовірно нижчим серед жінок І підгрупи (0,736±0,013) од., порівняно з хворими з ІІ підгрупи (0,830±0,018) од., що свідчило про глибші деструктивні зміни в уражених коронарних артеріях на ґрунті естрогенодефіциту.Висновки. Естрогенодефіцит у перименопаузальних жінок із ГКСбпST призводить до тяжких дифузних уражень коронарного русла: формування множинних гемодинамічно значимих стенозів та тромбозів на ґрунті виразнішого звиразкування атеросклеротичних бляшок у магістральних коронарних артеріях, виникнення грубих порушень міокардіальної перфузії та мікроциркуляції, що стає основою розвитку гострих порушень коронарного кровообігу в жінок.

The prognostic value of myocardial perfusion scintigraphy compared to coronary angiography in women with positive stress test results

Modern diagnostic strategy in coronary artery disease (CAD) makes it necessary not only to establish a diagnosis but also to assess the cardiovascular risk. It is not clear which strategy should be followed in the case of women with positive ECG stress test results to assess prognosis and start appropriate diagnostics and treatment.The aim of the study was to assess the prognostic value of myocardial perfusion scintigraphy in comparison with coronary angiography in women suspected of CAD and with positive ECG stress test results. The study population comprised 115 women (mean age 58.08 ± 8.8 years) suspected of CAD, with a history of chest pain and positive stress test results, who underwent myocardial perfusion scintigraphy. In 58 women coronary angiography was performed as the next step of the diagnostic procedure. All the patients were interviewed and had a physical examination, including the assessment of the cardiovascular risk in accordance with the SCORE (Systematic Coronary Risk Evaluation) scale and the probability of CAD (POST-TEST) in accordance with the ESC guidelines. The gated single photon emission computed tomography (GSPECT) with Tc-99m-MIBI was considered positive if moderate perfusion changes were observed in at least two segments or severe reversible perfusion disorders were found, regardless of the number of involved segments.The degree of coronary stenosis was assessed visually and changes greater than 50% stenosis of the luminal diameter were considered haemodynamically significant. The evaluation period covered 43.2 ± 30.8 months on average. The sensitivity of myocardial perfusion scintigraphy against cardiovascular events was 100% and the sensitivity of coronary angiography was 92.3%. The specificity was 93.1%and 88.9% respectively. The PPV of scintigraphy for cardiovascular events was 65% and of coronary angiography was 70.6%. The NPV was 100% and 97.6%respectively. The accuracy of myocardial perfusion scintigraphy for cardiovascular events was 93.9% and the accuracy of coronary angiography for cardiovascular events was 89.7%. The survival analysis confirmed the high prognostic value of SPECT and coronary angiography. However, if compared, myocardial perfusion scintigraphy was a better predictor of survival without cardiovascular events than coronary angiography was (c2 = 9.39, p < 0.01).The most important factors in assessing the cardiovascular risk in the study population included: positive result of myocardial perfusion scintigraphy, positive result of coronary angiography,and high SCORE and high POST-TEST values. Myocardial perfusion scintigraphy is superiorto coronary angiography in the prediction of necessary revascularisation procedures in women suspected of coronary artery disease and with positive stress test results.

The prognostic value of myocardial perfusion scintigraphy compared to coronary angiography in women with positive stress test results

BACKGROUND: Modern diagnostic strategy in coronary arterydisease (CAD) makes it necessary not only to establish a diagnosisbut also to assess the cardiovascular risk. It is not clearwhich strategy should be followed in the case of women withpositive ECG stress test results to assess prognosis and startappropriate diagnostics and treatment.The aim of the study was to assess the prognostic value ofmyocardial perfusion scintigraphy in comparison with coronaryangiography in women suspected of CAD and with positive ECGstress test results. MATERIAL AND METHODS: The study population comprised115 women (mean age 58.08 ± 8.8 years) suspected of CAD, witha history of chest pain and positive stress test results, who underwent myocardial perfusion scintigraphy. In 58 women coronaryangiography was performed as the next step of the diagnosticprocedure. All the patients were interviewed and had a physicalexamination, including the assessment of the cardiovascularrisk in accordance with the SCORE (Systematic Coronary RiskEvaluation) scale and the probability of CAD (POST-TEST) inaccordance with the ESC guidelines. The gated single photonemission computed tomography (GSPECT) with Tc-99m-MIBIwas considered positive if moderate perfusion changes wereobserved in at least two segments or severe reversible perfusiondisorders were found, regardless of the number of involved segments.The degree of coronary stenosis was assessed visuallyand changes greater than 50% stenosis of the luminal diameterwere considered haemodynamically significant. RESULTS: The evaluation period covered 43.2 ± 30.8 monthson average. The sensitivity of myocardial perfusion scintigraphyagainst cardiovascular events was 100% and the sensitivity ofcoronary angiography was 92.3%. The specificity was 93.1%and 88.9% respectively.The PPV of scintigraphy for cardiovascular events was 65% and ofcoronary angiography was 70.6%. The NPV was 100% and 97.6%respectively. The accuracy of myocardial perfusion scintigraphy forcardiovascular events was 93.9% and the accuracy of coronaryangiography for cardiovascular events was 89.7%. The survivalanalysis confirmed the high prognostic value of SPECT and coronaryangiography. However, if compared, myocardial perfusionscintigraphy was a better predictor of survival without cardiovascularevents than coronary angiography was (c2 = 9.39, p &lt; 0.01).The most important factors in assessing the cardiovascular riskin the study population included: positive result of myocardialperfusion scintigraphy, positive result of coronary angiography,and high SCORE and high POST-TEST values. CONCLUSIONS: Myocardial perfusion scintigraphy is superiorto coronary angiography in the prediction of necessary revascularisation procedures in women suspected of coronary arterydisease and with positive stress test results.

249 Sex-related differences in the treatment and outcomes of canadian acute coronary syndrome patients over the past decade

The question of whether gender-related disparities still exist in the treatment and outcomes of patients presenting with acute coronary syndromes (ACS) remains controversial. Using data from four registries spanning a decade, we sought to determine whether sex-related differences have persisted over time, and examined the treating physician's rationale for adopting a conservative management strategy in women compared to men. From January 1999 to December 2008, 14,196 patients with non-ST-segment elevation (NSTE)-ACS (without ST-segment elevation ≥0.1 mV in ≥2 contiguous leads or left-bundle branch block) were recruited into the Canadian Acute Coronary Syndrome I (ACSI; 1999-2001), ACSII (2002-2003), Global Registry of Acute Coronary Events (GRACE/GRACE2; 2004-2007), and Canadian Registry of Acute Coronary Events (CANRACE; 2008) prospective multicenter registries. A total of 4874 women and 9322 men were admitted with NSTE-ACS. Women were significantly older than men, and more likely to have a history of heart failure, diabetes, or hypertension, and less likely to have had prior revascularization. Fewer women were treated with ticlopidine/clopidogrel, heparin and glycoprotein IIb/IIIa inhibitors compared to men in the GRACE and CANRACE registries (P ≤ 0.05). Women were also less likely to undergo coronary angiography (Figure) and had higher unadjusted in-hospital mortality rates (2.7% vs. 1.6%, P < 0.001). Over time, significant increases were seen in the use of cardiac catheterization and PCI for both genders (all P for trend <0.001). Multivariable analysis confirmed that female gender was independently associated with lower in-hospital coronary angiography (adjusted odds ratio [aOR] 0.76, 95% confidence interval [CI] 0.69-0.84, P < 0.001) and higher in-hospital mortality (aOR 1.26, 95% CI 1.02-1.56, P = 0.036), irrespective of age (P for interaction = 0.76 for mortality). The lower use of coronary angiography in women was consistently seen over time. In the ACS-II registry, the reason most frequently cited by physicians for adopting a conservative approach was the perception that patients were “not high risk enough” in 52% of women compared with 47% of men (P = 0.24) who did not have coronary angiography. Despite temporal increases in the use of invasive cardiac procedures, women are still more likely to be treated conservatively with associated worse outcomes. Greater awareness of this treatment-risk paradox may assist in bridging the gender gap between current evidence-based guidelines and actual practice.

Abstract 4220: Low Calcium Score Does Not Exclude Significant Coronary Stenosis in Women at Intermediate Risk

Introduction : Coronary calcium deposition is associated with atherosclerosis and its quantification provides independent and incremental information to the clinical risk assessment. In women with low to intermediate clinical risk, how well zero or low calcium score predicts the absence of obstructive coronary artery disease (CAD) has not been elucidated. Hypothesis : To examine the extent of CAD on 64-slice multidetector computed tomography (MDCT) coronary angiography in women with zero or low calcium score. Methods : We studied 495 consecutive patients referred to coronary MDCT for clinically suspected CAD. Of these we identified 184 women with low to intermediate risk of CAD who had zero or low calcium score. A low calcium score was defined as an Agatston score of 1–100. Luminal stenosis of 50% or more was considered as obstructive CAD. Prevalence and severity of CAD were assessed and analyzed on per patient basis. Results : Calcium scores of 0 and 1–100 were found in 101 and 83 patients respectively. Patients with zero calcium score were younger (54.92 ± 10.34 vs. 61.21 ± 10.25 years, p = 0.0001), but none of the risk factors showed a significant difference as compared to patients with score of 1 - 100. Obstructive CAD was present in 4 patients (3.9%) with 0 calcium score as compared to 21 patients (22.9%) with calcium score of 1 - 100. (p = 0.0001) Later group also had more extensive disease, i.e., 2 patients had 3-vessel disease, 2 had 2-vessel disease. (p=0.05) Conclusions: In women with low to intermediate risk, although zero calcium score markedly reduces possibility of significant CAD; low calcium scores are significantly less predictive of prevalence or severity of underlying CAD. Low calcium score does not preclude the need for further assessment and MDCT coronary angiography might be a useful noninvasive imaging modality in this population.

Cardiovascular disease: an unwomanly disorder?

Cardiovascular disease: an unwomanly disorder?

Effect of coronary angiography on use of lipid-lowering agents in women: a report from the women’s ischemia syndrome evaluation (WISE) study

We sought to assess the impact of coronary angiography results on use of lipid-lowering agents among women enrolled in the Women’s Ischemia Syndrome Evaluation [WISE] study. WISE is a multicenter study designed to evaluate new diagnostic modalities among women undergoing angiography for suspected coronary artery disease (CAD). History of atherosclerosis, risk factors for CAD, and low-density lipoprotein (LDL) cholesterol are determined at baseline. The percentage of women at LDL cholesterol goal, use of lipid-lowering agents, and eligibility for lipid-lowering therapy were determined based on National Cholesterol Education Program II guidelines at baseline and 6-week follow-up. Among the 212 women for whom angiographic data were available, 84 had known atherosclerosis, 80 had no history of atherosclerosis but ≥2 risk factors (high risk), and 48 had no history of atherosclerosis and <2 risk factors (low risk). At baseline, LDL cholesterol goals were met in 24% women with atherosclerosis, in 56% high-risk women, and in 88% low-risk women. Angiography revealed previously undiagnosed CAD in 70% of the high-risk and in 42% of the low-risk women. After angiography results were available, 6 women started lipid-lowering therapy and 2 stopped. Based on National Cholesterol Education Program II guidelines, 63 additional women would have been eligible for pharmacologic lipid-lowering therapy. Intensification of lipid-lowering therapy was not apparent 6 weeks after coronary angiography in women with newly diagnosed CAD or among women whose diagnosis was confirmed.

Multiplane transoesophageal echocardiographic detection of thoracic aortic plaque is a marker for coronary artery disease in women

Objective: This study was conducted to examine if the multiplane transoesophageal echocardiographic detection of atherosclerotic plaque in the thoracic aorta could predict the absence or the presence and the severity of significant coronary artery disease in women. Its association with coronary disease is attractive and may have great influence on foregoing routine preoperative cardiac catheterization in patients with valvular heart disease but no data are available in women. Methods: Clinical and angiographic features and transoesophageal echocardiographic findings were prospectively analysed in 111 women. Results: In 24 women with significant coronary disease, 20 had thoracic aortic plaque on transoesophageal echocardiographic studies. In contrast, aortic plaque existed in only 12 of the remaining 87 women with normal or mildly abnormal coronary arteries. Therefore, the presence of aortic plaque had a sensitivity of 83%, a specificity of 86%, a positive and negative predictive values of 62% and 95%, respectively for the detection of significant coronary disease. There was a significant relation between the severity and the extent of atherosclerotic lesions and the angiographic coronary score ( P<0.0001). Multivariate logistic regression analysis revealed that aortic plaque was the most significant independent marker of coronary disease (odds ratio=27.9; 95% confidence interval=5.5–131.6; P<0.0001). Conclusions: This prospective study indicates that multiplane transoesophageal echocardiographic examination of thoracic atherosclerotic plaque is a marker for coronary disease in women and especially a powerful predictor of absence of significant coronary artery disease. Transoesophageal echocardiographic aortic examination might be used with risk factors and angina symptoms to discuss the need for preoperative coronary angiography in women with valvular heart disease.