The American Journal of Medicine
Volume 122, Issue 3 , Pages 301-309, March 2009

Impact of Gender on Risk Stratification by Stress Echocardiography

  • Lauro Cortigiani, MD

      Affiliations

    • Division of Cardiology, Campo di Marte Hospital, Lucca, Italy
  • ,
  • Rosa Sicari, MD

      Affiliations

    • Institute of Clinical Physiology, CNR, Pisa, Italy
    • Corresponding Author InformationRequests for reprints should be addressed to Rosa Sicari, MD, PhD, FESC, CNR Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124 Pisa, Italy
  • ,
  • Riccardo Bigi, MD

      Affiliations

    • Cardiology, Department of Medicine and Surgery, University School of Medicine, Milan, Italy
  • ,
  • Patrizia Landi, BSc

      Affiliations

    • Institute of Clinical Physiology, CNR, Pisa, Italy
  • ,
  • Francesco Bovenzi, MD

      Affiliations

    • Division of Cardiology, Campo di Marte Hospital, Lucca, Italy
  • ,
  • Eugenio Picano, MD

      Affiliations

    • Institute of Clinical Physiology, CNR, Pisa, Italy

Abstract 

Objective

To compare the prognostic value of stress echocardiography results in men and women with known and suspected coronary artery disease.

Methods

We analyzed the data of 8737 patients (5529 men and 3208 women) who underwent stress echocardiography (exercise in 523 patients, dipyridamole in 6227 patients, dobutamine in 1987) for evaluating known (n=3857) or suspected (n=4880) coronary artery disease. Patients were followed up for the occurrence of overall mortality or nonfatal myocardial infarction.

Results

During a median follow-up of 25 months, 1218 cardiac events (693 deaths and 525 infarctions) occurred. Moreover, 2263 patients (1731 men [31%] and 532 women [17%]; P<.0001) underwent coronary revascularization and were censored. Stress echocardiography results added prognostic information to that of clinical findings and resting wall motion score index in men and women with both known and suspected coronary artery disease. In patients with known coronary artery disease, women had a higher (P=.01) event rate than men in the presence of ischemia. The annual event rate was worse for nondiabetic women (P=.007) but not diabetic women; age had a neutral prognostic effect in the 2 sexes. In patients with suspected coronary artery disease, men without ischemia had a higher (P<.0001) event rate than women. The annual event rate was worse in men aged less than 65 years (P<.0001) or more than 65 years (P=.04), and those with (P=.03) or without (P<.0001) diabetes.

Conclusion

Prognosis is at least comparable in men and women with ischemia and in those with coronary artery disease and no ischemia at stress echocardiography. In these clinical settings, availability for major procedures should be similar for both genders.

Keywords: Gender gap, Prognosis, Stress echocardiography, Women

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 Funding: Financial support for the present study was received from institutional funding of the CNR, Institute of Clinical Physiology, Pisa, Italy.

 Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(08)01120-0

doi:10.1016/j.amjmed.2008.11.003

The American Journal of Medicine
Volume 122, Issue 3 , Pages 301-309, March 2009