Obstructive coronary artery disease in women presenting with ischemic chest pain: Prevalence and risk determinants

Background: Women present more commonly with atypical angina, false-positive exercise test, and normal/nonobstructive coronary angiogram. It thus becomes essential to identify the predictors of obstructive coronary artery disease (CAD) in women to avoid unnecessary invasive angiograms. Methods: We prospectively recorded the data of consecutive 578 women who underwent coronary angiography in our institute for typical/atypical chest pain suspected to be secondary to CAD. Results: Normal coronaries/nonobstructive CAD were seen in 273 (47.2%) patients, whereas 305 (52.8%) patients were found to have obstructive CAD (P < 0.0001). On multivariate logistic regression analysis, the presence of typical angina, age >55 years, smoking, diabetes mellitus, hypertension, low-density lipoprotein cholesterol >150 mg/dl, and high-density lipoprotein cholesterol <40 mg/dl were found to be independent predictors of obstructive CAD. Conclusion: These risk predictors can help in the reliable assessment of pretest likelihood of obstructive CAD in women, thereby avoiding many unnecessary invasive coronary angiograms. Further larger studies are warranted to validate these results and propose accurate prediction models for the diagnosis of obstructive CAD in women.