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Jones E, Delia Johnson B, Shaw LJ, et al. Not typical angina and mortality in women with obstructive coronary artery disease: Results from the Women's Ischemic Syndrome Evaluation study (WISE). Int J Cardiol Heart Vasc. 2020;27:100502doi: 10.1016/j.ijcha.2020.100502.
Jones, E., Delia Johnson, B., Shaw, L. J., Bakir, M., Wei, J., Mehta, P. K., Minissian, M., Pepine, C. J., Reis, S. E., Kelsey, S. F., Handberg, E., Bittner, V., Sopko, G., & Noel Bairey Merz, C. (2020). Not typical angina and mortality in women with obstructive coronary artery disease: Results from the Women's Ischemic Syndrome Evaluation study (WISE). International journal of cardiology. Heart & vasculature, 27100502. https://doi.org/10.1016/j.ijcha.2020.100502
Jones, Erika, et al. "Not typical angina and mortality in women with obstructive coronary artery disease: Results from the Women's Ischemic Syndrome Evaluation study (WISE)." International journal of cardiology. Heart & vasculature vol. 27 (2020): 100502. doi: https://doi.org/10.1016/j.ijcha.2020.100502
Jones E, Delia Johnson B, Shaw LJ, Bakir M, Wei J, Mehta PK, Minissian M, Pepine CJ, Reis SE, Kelsey SF, Handberg E, Bittner V, Sopko G, Noel Bairey Merz C. Not typical angina and mortality in women with obstructive coronary artery disease: Results from the Women's Ischemic Syndrome Evaluation study (WISE). Int J Cardiol Heart Vasc. 2020 Mar 24;27:100502. doi: 10.1016/j.ijcha.2020.100502. eCollection 2020 Apr. PMID: 32226820; PMCID: PMC7093808.
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Int J Cardiol Heart Vasc. 2020 Mar 24;27:100502. doi: 10.1016/j.ijcha.2020.100502. eCollection 2020 Apr.

Not typical angina and mortality in women with obstructive coronary artery disease: Results from the Women's Ischemic Syndrome Evaluation study (WISE).

International journal of cardiology. Heart & vasculature

Erika Jones, B Delia Johnson, Leslee J Shaw, May Bakir, Janet Wei, Puja K Mehta, Margo Minissian, Carl J Pepine, Steven E Reis, Sheryl F Kelsey, Eileen Handberg, Vera Bittner, George Sopko, C Noel Bairey Merz

Affiliations

  1. Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, United States.
  2. University of Pittsburgh, Pittsburgh, PA, United States.
  3. Emory University, Atlanta, GA, United States.
  4. University of Florida, Gainesville, FL, United States.
  5. University of Alabama at Birmingham, Birmingham, AL, United States.
  6. National Heart, Lung, and Blood Institute, Bethesda, MD, United States.

PMID: 32226820 PMCID: PMC7093808 DOI: 10.1016/j.ijcha.2020.100502

Abstract

BACKGROUND: Women frequently present with symptoms not typical of angina (NTA) making ischemic heart disease recognition, diagnosis and treatment challenging. We compared mortality in women with obstructive coronary artery disease (CAD) with NTA vs typical angina (TA).

METHODS: We studied 326 Women's Ischemia Syndrome Evaluation (WISE) participants undergoing coronary angiography for suspected myocardial ischemia with core-lab measured obstructive CAD. TA was defined as sub-sternal chest pain precipitated by physical exertion or emotional stress and relieved with rest or nitroglycerin; NTA did not meet criteria for TA. The women were followed for non-fatal events and death for a median of 5.9 and 9.6 years respectively. Multivariate cox proportional hazards regression determined relations to events.

RESULTS: Overall, 115 (35%) of the women had TA. Baseline demographics, risk factors or additional symptom characteristics were similar between the two angina groups. Non-fatal events did not differ between groups. Women with NTA had a higher mortality compared to TA women (36% vs 26%, respectively, p = 0.047). Despite adjustment for additional major risk variables, NTA was an independent predictor of mortality compared to TA with a hazard ratio of 1.73 (95% Confidence interval: 1.04, 2.89).

CONCLUSIONS: Among women with suspected ischemia undergoing coronary angiography with obstructive CAD, NTA was more common than TA, and predicted a higher longer-term mortality. Further investigation is needed to confirm these results, and investigate potential explanations for the higher mortality observed in women with NTA women, including lower recognition or action in the setting of obstructive CAD.

© 2020 Published by Elsevier B.V.

Keywords: Angina; Coronary artery disease; Mortality

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