Women undergoing first-time invasive coronary angiography for suspected NSTE-ACS had a significantly higher rate of no significant CAD compared to men (40.9% vs 17.2%; aRR 2.59, 95% CI 2.51-2.67).
Cohort (n=92,746)
Yes
Are there sex differences in the diagnostic yield of invasive coronary angiography in adults with suspected NSTE-ACS?
Women undergoing first-time invasive coronary angiography for suspected NSTE-ACS are approximately twice as likely as men to have no significant coronary artery disease, highlighting a need for improved risk stratification.
Relative Risk: 2.59 (95% CI 2.51–2.67)
Absolute Event Rate: 40.9% vs 17.2%
Background: Sex differences in the diagnostic yield of invasive coronary angiography (ICA) in non–ST-elevation acute coronary syndrome (NSTE-ACS) are well established, but contemporary population-level data incorporating high-sensitivity troponin era cohorts and cross-national validation remain limited. Objectives: The objectives of the study were to assess sex differences in diagnostic yield, revascularization rates, and 1-year outcomes in patients undergoing first-time ICA for suspected NSTE-ACS. Methods: Using data from the Swedish Coronary Angiography and Angioplasty Registry with validation in the Western Denmark Heart Registry. Adults without previously known coronary artery disease (CAD) undergoing first-time ICA for suspected NSTE-ACS were included. The primary outcome was the absence of significant CAD, defined as a normal angiography or <50% stenosis in all major epicardial vessels. Multivariable Poisson regression models were used to estimate adjusted risk ratios (aRRs). Secondary outcomes were 1-year major adverse cardiovascular events, comparing women and men with and without obstructive CAD using Kaplan-Meier estimates and adjusted Cox proportional hazards models. Results: A total of 74,883 and 17,863 patients were included from Sweden and Western Denmark. Women had approximately twice the proportion without significant CAD compared to men in Swedish Coronary Angiography and Angioplasty Registry (40.9% vs 17.2%; aRR: 2.59; 95% CI: 2.51-2.67) and Western Denmark Heart Registry (50.1% vs 25.2%; aRR: 2.01; 95% CI: 1.95-2.08). In women below the age of 50 without any traditional cardiovascular risk factors, 74.8% had no significant CAD. Conclusions: In 2 population-based cohorts undergoing first-time ICA for suspected NSTE-ACS, 40 to 50% of women had no significant CAD, approximately twice the proportion to men, highlighting ongoing challenges in risk stratification of patients referred for ICA.
Zhou et al. (Mon,) conducted a cohort in suspected NSTE-ACS (n=92,746). Female sex vs. Male sex was evaluated on absence of significant CAD, defined as a normal angiography or <50% stenosis in all major epicardial vessels (aRR 2.59, 95% CI 2.51-2.67). Women undergoing first-time invasive coronary angiography for suspected NSTE-ACS had a significantly higher rate of no significant CAD compared to men (40.9% vs 17.2%; aRR 2.59, 95% CI 2.51-2.67).