JACC: Cardiovascular Imaging
Original Research
Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery DiseaseInsights From the PROMISE Trial
Kshipra Hemal, Neha J. Pagidipati, Adrian Coles, Rowena J. Dolor, Daniel B. Mark, Patricia A. Pellikka, Udo Hoffmann, Sheldon E. Litwin, Melissa A. Daubert, Svati H. Shah, Kevin Ariani, Renée P. Bullock-Palmer, Beth Martinez, Kerry L. Lee and Pamela S. Douglas
Table 5
Table 5
Association Between Overall Test Positivity and Presentation Characteristics in Women and Men
| Men (N = 4,246) | Women (N = 4,720) | |||||
|---|---|---|---|---|---|---|
| Negative (n = 3,606) | Positive (n = 640) | p Value | Negative (n = 4,262) | Positive (n = 458) | p Value | |
| Demographics | ||||||
| Age, yrs | ||||||
| All patients | 58.4 ± 8.2∗ | 61.8 ± 8.6∗ | <0.001∗ | 62.2 ± 7.7∗ | 64.4 ± 8.0∗ | <0.001∗ |
| Patients >50 yrs | 2,995∗ (83.1) | 583∗ (91.1) | <0.001∗ | 4,261 (>99.9) | 458 (100) | >0.999 |
| Racial or ethnic minority | 808∗ (22.6) | 105∗ (16.5) | <0.001∗ | 962 (22.7) | 90 (19.8) | 0.154 |
| Physical examinations | ||||||
| BMI (kg/m2) | 30.5 ± 5.4 | 30.4 ± 5.5 | 0.978 | 30.3 ± 6.4∗ | 31.5 ± 7.3∗ | 0.004∗ |
| Overweight (BMI ≥25 kg/m2) | 3,096 (86.6) | 541 (85.2) | 0.350 | 3,367 (79.7) | 370 (81.1) | 0.481 |
| Risk factors | ||||||
| Hypertension | 2,240∗ (62.1) | 433∗ (67.7) | 0.008∗ | 2,804∗ (65.8) | 333∗ (72.7) | 0.003∗ |
| Diabetes | 717∗ (19.9) | 166∗ (25.9) | <0.001∗ | 902∗ (21.2) | 123∗ (26.9) | 0.005∗ |
| Dyslipidemia | 2,376 (65.9) | 436 (68.1) | 0.271 | 2,927 (68.7) | 331 (72.3) | 0.114 |
| Cerebrovascular or peripheral vascular disease | 159 (4.4) | 38 (5.9) | 0.089 | 249∗ (5.8) | 38∗ (8.3) | 0.037∗ |
| Family history of premature CAD | 1,052 (29.3) | 185 (29.0) | 0.892 | 1,442 (34.0) | 160 (35.0) | 0.650 |
| History of depression | 534 (14.8) | 91 (14.2) | 0.698 | 1,105 (25.9) | 121 (26.4) | 0.822 |
| Metabolic syndrome | 1,365 (37.9) | 261 (40.8) | 0.160 | 1,553∗ (36.4) | 208∗ (45.4) | <0.001∗ |
| Current or former smoker | 2,022∗ (56.1) | 398∗ (62.2) | 0.004∗ | 1,940 (45.5) | 222 (48.5) | 0.230 |
| Sedentary | 1,553 (43.1) | 300 (46.9) | 0.070 | 2,243 (52.6) | 262 (57.2) | 0.057 |
| Primary presenting symptoms | ||||||
| Chest pain† | 2,617 (72.7) | 450 (70.3) | 0.219 | 3,113 (73.1) | 342 (74.7) | 0.458 |
| Chest pain characterization‡ | ||||||
| Aching/dull | 726 (27.7) | 121 (26.9) | 0.709 | 734 (23.6) | 74 (21.6) | 0.421 |
| Burning/pins and needles | 261∗ (10.0) | 61∗ (13.6) | 0.022∗ | 261 (8.4) | 34 (9.9) | 0.328 |
| Crushing/pressure/squeezing/tightness | 1,213 (46.4) | 200 (44.4) | 0.454 | 1,632∗ (52.4) | 200∗ (58.5) | 0.033∗ |
| Other | 826 (31.6) | 125 (27.8) | 0.109 | 921 (29.6) | 91 (26.6) | 0.251 |
| Shortness of breath/dyspnea | 538 (14.9) | 101 (15.8) | 0.584 | 634 (14.9) | 73 (15.9) | 0.546 |
| Other§ | 446 (12.4) | 89 (13.9) | 0.286 | 514 (12.1) | 43 (9.4) | 0.092 |
| Physician characterization of typicality of chest pain | ||||||
| Typical (definite angina) | 381∗ (10.6) | 120∗ (18.8) | <0.001∗ | 475 (11.1) | 51 (11.1) | 0.995 |
| Atypical (possible angina) | 2,848∗ (79.0) | 469∗ (73.3) | <0.001∗ | 3,312 (77.7) | 359 (78.4) | 0.742 |
| Nonangina | 377∗ (10.5) | 51∗ (8.0) | <0.001∗ | 475 (11.1) | 48 (10.5) | 0.667 |
| Assessment of risk | ||||||
| Framingham risk score (23) | <0.001∗ | <0.001∗ | ||||
| Mean ± SD | 27.7 ± 15.8∗ | 34.2 ± 18.0∗ | 14.7 ± 9.6∗ | 18.0 ± 11.2∗ | ||
| Median (IQR) | 24.0∗ (15.6–36.0) | 31.1∗ (20.3–44.6) | 12.0∗ (8.0–18.5) | 14.7∗ (10.1–23.9) | ||
| Min, max | 3.8, 97.0 | 2.4, 99.6 | 1.6, 78.4 | 2.9, 62.6 | ||
| ASCVD pooled cohort risk prediction (24) | <0.001∗ | <0.001∗ | ||||
| Mean ± SD | 16.2 ± 10.9∗ | 21.1 ± 13.3∗ | 12.2 ± 11.2∗ | 15.8 ± 12.6∗ | ||
| Median (IQR) | 13.4∗ (8.1–21.4) | 17.8∗ (10.9–28.2) | 8.5∗ (4.6–15.5) | 12.3∗ (6.3–21.9) | ||
| Min, max | 1.2, 75.0 | 0.9, 97.8 | 0.6, 82.0 | 1.1, 76.5 | ||
| Diamond and Forrester (25) | <0.001∗ | 0.003∗ | ||||
| Mean ± SD | 59.4 ± 17.3∗ | 65.2 ± 17.7∗ | 45.9 ± 19.8∗ | 48.3 ± 19.3∗ | ||
| Median (IQR) | 58.9∗ (58.9–67.1) | 67.1∗ (58.9–67.1) | 54.4∗ (32.4–54.4) | 54.4∗ (32.4–54.4) | ||
| Min, max | 14.1, 94.3 | 14.1, 94.3 | 8.4, 90.6 | 8.4, 90.6 | ||
| Modified Diamond and Forrester (26) | <0.001∗ | <0.001∗ | ||||
| Mean ± SD | 53.4 ± 13.2∗ | 59.5 ± 14.1∗ | 28.2 ± 12.2∗ | 30.0 ± 12.8∗ | ||
| Median (IQR) | 48.9∗ (48.9–59.4) | 59.4∗ (48.9–69.2) | 27.7∗ (20.0–27.7) | 27.7∗ (20.0–37.0) | ||
| Min, max | 24.8, 92.5 | 24.8, 92.5 | 11.7, 76.3 | 11.7, 76.3 | ||
| Combined Diamond-Forrester and CASS (27) | <0.001∗ | 0.003∗ | ||||
| Mean ± SD | 63.6 ± 17.9∗ | 69.0 ± 17.5∗ | 43.0 ± 18.9∗ | 45.2 ± 18.6∗ | ||
| Median (IQR) | 65.0∗ (65.0–72.0) | 72.0∗ (65.0–72.0) | 51.0∗ (31.0–51.0) | 51.0∗ (31.0, 51.0) | ||
| Min, max | 13.0, 94.0 | 13.0, 94.0 | 7.0, 86.0 | 7.0, 86.0 | ||
| Physician assessment of likelihood of epicardial stenosis‖ | ||||||
| Very low and low (<30%) | 1,303∗ (36.2) | 168∗ (26.3) | <0.001∗ | 1,763∗ (41.4) | 163∗ (35.7) | 0.019∗ |
| Intermediate (31%–70%) | 2,122 (58.9) | 385 (60.3) | 0.488 | 2,370 (55.7) | 257 (56.4) | 0.783 |
| High and very high (>70%) | 179∗ (5.0) | 85∗ (13.3) | <0.001∗ | 123∗ (2.9) | 36∗ (7.9) | <0.001∗ |
Values are mean ± SD or n (%), unless indicated otherwise.
Abbreviations as in Table 1.
↵∗ Significant results.
↵† Chest pain: substernal or left anterior or chest pain: other are selected as primary symptoms. Multiple characterizations are possible.
↵‡ Only applicable when chest pain: substernal or left anterior or chest pain: other are selected as primary symptoms. Multiple choices possible.
↵§ Includes diaphoresis and/or sweating, dizziness and/or lightheaded, epigastric and/or abdominal pain, nausea and/or vomiting, syncope, arm or shoulder pain, back pain, fatigue and/or weakness, neck or jaw pain, palpitations, and other.
↵‖ Provider’s assessment of the likelihood that subject has significant epicardial coronary stenosis or left main stenosis. Significant refers to ≥70% epicardial coronary stenosis or ≥50% left main stenosis.
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