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. 2020 Mar 24:27:100502.
doi: 10.1016/j.ijcha.2020.100502. eCollection 2020 Apr.

Not typical angina and mortality in women with obstructive coronary artery disease: Results from the Women's Ischemic Syndrome Evaluation study (WISE)

Erika Jones  1 , B Delia Johnson  2 , Leslee J Shaw  3 , May Bakir  1 , Janet Wei  1 , Puja K Mehta  1 , Margo Minissian  1 , Carl J Pepine  4 , Steven E Reis  2 , Sheryl F Kelsey  2 , Eileen Handberg  4 , Vera Bittner  5 , George Sopko  6 , C Noel Bairey Merz  1
Affiliations

Not typical angina and mortality in women with obstructive coronary artery disease: Results from the Women's Ischemic Syndrome Evaluation study (WISE)

Erika Jones et al. Int J Cardiol Heart Vasc. .

Erratum in

Abstract

Background: Women frequently present with symptoms not typical of angina (NTA) making ischemic heart disease recognition, diagnosis and treatment challenging. We compared mortality in women with obstructive coronary artery disease (CAD) with NTA vs typical angina (TA).

Methods: We studied 326 Women's Ischemia Syndrome Evaluation (WISE) participants undergoing coronary angiography for suspected myocardial ischemia with core-lab measured obstructive CAD. TA was defined as sub-sternal chest pain precipitated by physical exertion or emotional stress and relieved with rest or nitroglycerin; NTA did not meet criteria for TA. The women were followed for non-fatal events and death for a median of 5.9 and 9.6 years respectively. Multivariate cox proportional hazards regression determined relations to events.

Results: Overall, 115 (35%) of the women had TA. Baseline demographics, risk factors or additional symptom characteristics were similar between the two angina groups. Non-fatal events did not differ between groups. Women with NTA had a higher mortality compared to TA women (36% vs 26%, respectively, p = 0.047). Despite adjustment for additional major risk variables, NTA was an independent predictor of mortality compared to TA with a hazard ratio of 1.73 (95% Confidence interval: 1.04, 2.89).

Conclusions: Among women with suspected ischemia undergoing coronary angiography with obstructive CAD, NTA was more common than TA, and predicted a higher longer-term mortality. Further investigation is needed to confirm these results, and investigate potential explanations for the higher mortality observed in women with NTA women, including lower recognition or action in the setting of obstructive CAD.

Keywords: Angina; Coronary artery disease; Mortality.

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Figures

Fig. 1
Fig. 1
Fully adjusted Kaplan-Meier plot for 10-year All-Cause Mortality in Not-Typical Angina (NTA) (n = 211) vs Typical Angina (TA) (n = 115).
See this image and copyright information in PMC

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