European Heart Journal Advance Access originally published online on May 23, 2006
European Heart Journal 2006 27(12):1408-1415; doi:10.1093/eurheartj/ehl040
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Persistent chest pain predicts cardiovascular events in women without obstructive coronary artery disease: results from the NIH-NHLBI-sponsored Women's Ischaemia Syndrome Evaluation (WISE) study
1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
2 Division of Cardiology, Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
3 Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
4 Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
5 National Heart, Lung and Blood Institute, NIH, Bethesda, MD, USA
6 Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
7 Division of Cardiology, Department of Medicine, Allegheny University of the Health Sciences, Pittsburgh, PA, USA
8 Division of Cardiology, Rhode Island Hospital, RI, USA
Received 21 October 2005; revised 14 April 2006; accepted 4 May 2006; online publish-ahead-of-print 23 May 2006.
* Corresponding author. Tel: +1 412 624 7256; fax: +1 412 624 3775. E-mail address: djohnson{at}edc.pitt.edu
See page 1387 for the editorial comment on this article (doi:10.1093/eurheartj/ehi758)
Aims Women with chest pain but without obstructive coronary artery disease (CAD) are considered at low risk for cardiovascular (CV) events, but half continue to experience debilitating chest pain over many years. This study compared CV outcomes in women with persistent chest pain (PChP) vs. those without PChP.
Methods and results We studied 673 Women's Ischaemia Syndrome Evaluation (WISE) participants with chest pain undergoing coronary angiography for suspected myocardial ischaemia and at least 1 year of follow-up. PChP was defined as self-reported continuing chest pain after 1 year. Events occurring after that year were recorded for a median of 5.2 years. We compared CV event rates for women with and without PChP in subgroups with and without obstructive CAD. The median age was 58 years, 20% were racial minorities, 45% had PChP, 39% had obstructive CAD. Among women without CAD, those with PChP had more than twice the rate of composite CV events (P=0.03), that included non-fatal myocardial infarctions (P=0.11), strokes (P=0.03), congestive heart failure (P=0.38), and CV deaths (P=0.73), compared with those without PChP. In women with CAD, there was no difference in composite CV events in those with and without PChP (P=0.72).
Conclusion Among women undergoing coronary angiography for suspected myocardial ischaemia, PChP in women with no obstructive CAD predicted adverse CV outcomes. Such women might benefit from additional evaluation and aggressive risk factor modification therapy.
Key Words: Chest pain • Prognosis • Women • Myocardial ischaemia
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