Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery DiseaseInsights From the PROMISE Trial
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.