The Impact of Gender: Rates of Significant Coronary Artery Disease in Women and Men Undergoing Non-Invasive and Invasive Ischemic Evaluation for Acute Coronary Syndromes

Introduction: Key differences in the presentation and pathophysiology of cardiovascular disease (CVD) between men and women exacerbate diagnostic challenges when evaluating patients with acute coronary syndromes (ACS). Hypothesis: We aimed to better understand the impact of gender on diagnostic approaches and findings in similar cohorts of men and women who presented to rule out ACS and were evaluated with non-invasive cardiac imaging (NI) including Computed Tomography Coronary Angiography (CTCA) or Nuclear Stress Test (NST) prior to coronary angiography (CA). Methods: We performed a retrospective chart review to evaluate all patients referred to our catheterization laboratory for ACS over 1 year. Patients with a history of CVD, end stage renal disease or who underwent CA without NI were excluded. Statistical analysis was performed with Paired-T and Mann Whitney U Testing, and CHI-Square analysis. Results: 150 patients (45 women and 105 men) met our study criteria. There were no significant differences between men and women in age, BMI, GFR, Troponin, BNP, rates of hypertension, diabetes mellitus, hyperlipidemia, obesity, smoking history or utilization of aspirin, or statins. Grace Scores and Diamond Forrester Risk were similar. Women were less likely than men to have significant coronary disease on CA (M:66% W:34% p=0.00) or require intervention (M:73% W:34% p=0.00). There were no significant differences in rates of reported coronary disease on NI testing (M:53%, W:55% p=0.81), however, rates of artifact in NI testing were significantly higher in women (M:26% W:55% p=0.00). Women were significantly more likely to undergo NST rather than CTCA (M:22%, W:45% p=0.00). Conclusions: Our study found that women were far less likely to have significant coronary disease on CA after a NI workup, were more likely to have NI studies with reported artifact and were more likely to undergo NST than CTCA. We highlight differences between genders in significant CAD and need for intervention that may be related to higher rates artifact in NI results in women. Furthermore, we demonstrate the correlation with gender and physician decision making when selecting NI imaging, a finding which warrants further study.