Gender differences in diagnosis of chronic coronary syndrome: new recommendations and our actual practice

Objective. To evaluate a new model of risk factor-weighted clinical likelihood (RF-CL) in diagnosis of chronic coronary syndrome (CCS) taking into account gender differences. Material and methods. The registry study included 69 men and 62 women (age 66.8±10.2 years) who were examined for suspected coronary artery disease. All patients with various risk factors and clinical manifestations of CCS underwent diagnostic searching in accordance with the Russian guidelines “Stable coronary artery disease” (2024), as well as analysis of clinical likelihood of coronary artery disease using the RF-CL model was performed. Results. When comparing clinical likelihood of obstructive coronary artery disease according to RF-CL data, men showed higher values compared to women (21.6±12.6% and 8.2±5.9, respectively, p<0.34). Significant differences in RF-CL were obtained for both groups: moderate (RF-CL>15—50%) for men and women — 68% and 11% (p<0.001), low (RF-CL>5—15%) — 27% and 58% (p<0.001), very low (RF-CL≤5%) — 4% and 31%, respectively (p<0.001). The prevalence of typical (28% vs. 20%, p=0.39) and atypical angina (21% vs. 25%, respectively, p=0.67), as well as non-cardiac chest pain (31% vs. 23%, p=0.4) did not differ between groups. However, dyspnea was more common among women (39% vs. 66%, p=0.005). Only 17 (13%) ones who underwent stress test had indications for invasive coronary angiography. At the same time, 10 (8%) patients had stenoses ≥70%. Conclusion. A new RF-CL model on a small cohort demonstrates the need for its use on a larger sample, as it emphasizes excessive number of stress tests (especially for women) in case of adherence of attending physicians to traditional Diamond–Forrester pre-test probability algorithm.