Impact of Gender on Risk Stratification by Stress Echocardiography

OBJECTIVE: To compare the prognostic value of stress echocardiography results in men and women with known and suspected coronary artery disease. METHODS: We analyzed the data of 8737 patients (5529 men and 3208 women) who underwent stress echocardiography (exercise in 523 patients, dipyridamole in 6227 patients, dobutamine in 1987) for evaluating known (n=3857) or suspected (n=4880) coronary artery disease. Patients were followed up for the occurrence of overall mortality or nonfatal myocardial infarction. RESULTS: During a median follow-up of 25 months, 1218 cardiac events (693 deaths and 525 infarctions) occurred. Moreover, 2263 patients (1731 men 31% and 532 women 17%; P<.0001) underwent coronary revascularization and were censored. Stress echocardiography results added prognostic information to that of clinical findings and resting wall motion score index in men and women with both known and suspected coronary artery disease. In patients with known coronary artery disease, women had a higher (P=.01) event rate than men in the presence of ischemia. The annual event rate was worse for nondiabetic women (P=.007) but not diabetic women; age had a neutral prognostic effect in the 2 sexes. In patients with suspected coronary artery disease, men without ischemia had a higher (P<.0001) event rate than women. The annual event rate was worse in men aged less than 65 years (P<.0001) or more than 65 years (P=.04), and those with (P=.03) or without (P<.0001) diabetes. CONCLUSION: Prognosis is at least comparable in men and women with ischemia and in those with coronary artery disease and no ischemia at stress echocardiography. In these clinical settings, availability for major procedures should be similar for both genders.