Chest pain in women: clinical, investigative, and prognostic features

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Abstract
Objective: To characterise clinical, investigative, and prognostic features of women referred with chest pain who subsequently underwent coronary angiography. Design: Analysis of all women with angina referred to one consultant during 1987-91 who subsequently underwent coronary angiography, with follow up to present day. Setting: Cardiothoracic centre Subjects: Women with normal coronary arteries; women with coronary artery disease shown on angiography; men with coronary artery disease matched for age; men referred with chest pain during the same period subsequently found to have normal coronary arteries. Main outcome measures: Risk factor analysis; results of exercise testing and coronary angiography; intervention; morbidity and mortality. Results: Women comprised 23% (202/886) of patients referred with chest pain who subsequently underwent angiography. 83/202 women had normal coronary angiograms compared with 55/684 men (41% v 8%, PConclusions: In this series, although women comprised the minority of patients referred with chest pain, a diagnosis of normal coronary arteries was five times more common in women than men. Risk factor analysis and exercise testing were of limited value in predicting coronary artery disease in women. There was no sex bias regarding revascularisation procedures, and outcome was similar. A diagnosis of non-cardiac chest pain in patients with normal coronary arteries was of little benefit to the patient with regard to morbidity.