Sex differences in investigation results and treatment in subjects referred for investigation of chest pain

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Abstract
OBJECTIVE To evaluate differences in investigation results and treatment between men and women referred for diagnostic treadmill exercise testing and coronary arteriography. DESIGN Cohort study. SETTING Tertiary cardiology centre. SUBJECTS 1522 subjects referred by primary care physicians to an open access chest pain clinic for initial investigation of chest pain, of whom 485 were subsequently referred for coronary arteriography; and a similar cohort of 107 subjects referred directly by secondary care physicians for diagnostic coronary arteriography. MAIN OUTCOME MEASURES Rates of positive exercise tests and rates for referral for arteriography and revascularisation according to sex. RESULTS Overall, women were less likely to be referred for arteriography and revascularisation than men. However, men were more likely to have positive exercise tests, and for various exercise test diagnostic end points men were also more likely to have significant coronary artery disease. After taking this into account, there was no sex difference in referral rates for arteriography or revascularisation. CONCLUSIONS There was no evidence of a sex bias resulting in inappropriate underinvestigation or undertreatment of women. However, the positive predictive value of treadmill exercise testing is low for women and further research is needed into how best to investigate women with chest pain.