Sex differences in evaluation and outcome after stress testing

Veronique Lee Roger, Steven J. Jacobsen, Susan A. Weston, Patricia Pellikka, Todd D. Miller, Kent R Bailey, Bernard J. Gersh

Research output: Contribution to journalArticle

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Abstract

Objective: To examine sex differences in evaluation and outcome after stress testing for coronary artery disease (CAD) in a geographically defined cohort. Subjects and Methods: Subjects were residents of Olmsted County, Minnesota, who underwent an initial stress test between January 1, 1987, and December 31, 1990. End points included referral for coronary angiography, death, and cardiac events, defined as cardiac death, nonfatal myocardial infarction, or congestive heart failure. Results: A total of 2276 men and 1270 women underwent stress tests. Women were older and had more risk factors and comorbidities (P<.05). Among persons without documented CAD (86% of the cohort), the median probability of CAD was 11% (interquartile range, 5%-25%) for men and 8% (interquartile range, 2%-31%) for women (P<.001). Within 6 months after stress testing, 9% of men and 7% of women underwent coronary angiography. Among persons without documented CAD, there was no sex difference in referral for angiography when the stress test result was negative. When the test result was positive, men were more likely to be referred for angiography (adjusted odds ratio [OR] for male sex, 2.02; 95% confidence interval [CI], 1.21-3.38; P=.008). After adjusting for the predicted probability of CAD, this association was no longer detected (adjusted OR for male sex, 0.67; 95% CI, 0.26-1.73; P=.41). Among persons with documented CAD, no sex difference was noted. After a mean ± SD follow-up of 7.6±2.7 years and among persons without documented CAD, male sex was associated with a higher adjusted risk of death (relative risk for male sex, 1.40; 95% CI, 1.05-1.86; P=.02) and cardiac events (relative risk for male sex, 1.67; 95% CI, 1.24-2.26; P<.001). Among persons with documented CAD, no sex difference in outcome was noted. Conclusion: These population-based data indicate that, when the diagnosis of CAD was not established, there was a greater use of angiography among men with positive stress test results, which could be attributed to the increased probability of CAD in men. In the absence of documented CAD, men fared worse than women, with an increase in the risk of death and cardiac events. Among persons with documented CAD, no sex difference in use of angiography and outcome was noted.

Original languageEnglish (US)
Pages (from-to)638-645
Number of pages8
JournalMayo Clinic Proceedings
Volume77
Issue number7
StatePublished - 2002

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Sex Characteristics
Coronary Artery Disease
Exercise Test
Angiography
Confidence Intervals
Coronary Angiography
Referral and Consultation
Odds Ratio
Comorbidity
Heart Failure
Myocardial Infarction

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Roger, V. L., Jacobsen, S. J., Weston, S. A., Pellikka, P., Miller, T. D., Bailey, K. R., & Gersh, B. J. (2002). Sex differences in evaluation and outcome after stress testing. Mayo Clinic Proceedings, 77(7), 638-645.

Sex differences in evaluation and outcome after stress testing. / Roger, Veronique Lee; Jacobsen, Steven J.; Weston, Susan A.; Pellikka, Patricia; Miller, Todd D.; Bailey, Kent R; Gersh, Bernard J.

In: Mayo Clinic Proceedings, Vol. 77, No. 7, 2002, p. 638-645.

Research output: Contribution to journalArticle

Roger, VL, Jacobsen, SJ, Weston, SA, Pellikka, P, Miller, TD, Bailey, KR & Gersh, BJ 2002, 'Sex differences in evaluation and outcome after stress testing', Mayo Clinic Proceedings, vol. 77, no. 7, pp. 638-645.
Roger, Veronique Lee ; Jacobsen, Steven J. ; Weston, Susan A. ; Pellikka, Patricia ; Miller, Todd D. ; Bailey, Kent R ; Gersh, Bernard J. / Sex differences in evaluation and outcome after stress testing. In: Mayo Clinic Proceedings. 2002 ; Vol. 77, No. 7. pp. 638-645.
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abstract = "Objective: To examine sex differences in evaluation and outcome after stress testing for coronary artery disease (CAD) in a geographically defined cohort. Subjects and Methods: Subjects were residents of Olmsted County, Minnesota, who underwent an initial stress test between January 1, 1987, and December 31, 1990. End points included referral for coronary angiography, death, and cardiac events, defined as cardiac death, nonfatal myocardial infarction, or congestive heart failure. Results: A total of 2276 men and 1270 women underwent stress tests. Women were older and had more risk factors and comorbidities (P<.05). Among persons without documented CAD (86{\%} of the cohort), the median probability of CAD was 11{\%} (interquartile range, 5{\%}-25{\%}) for men and 8{\%} (interquartile range, 2{\%}-31{\%}) for women (P<.001). Within 6 months after stress testing, 9{\%} of men and 7{\%} of women underwent coronary angiography. Among persons without documented CAD, there was no sex difference in referral for angiography when the stress test result was negative. When the test result was positive, men were more likely to be referred for angiography (adjusted odds ratio [OR] for male sex, 2.02; 95{\%} confidence interval [CI], 1.21-3.38; P=.008). After adjusting for the predicted probability of CAD, this association was no longer detected (adjusted OR for male sex, 0.67; 95{\%} CI, 0.26-1.73; P=.41). Among persons with documented CAD, no sex difference was noted. After a mean ± SD follow-up of 7.6±2.7 years and among persons without documented CAD, male sex was associated with a higher adjusted risk of death (relative risk for male sex, 1.40; 95{\%} CI, 1.05-1.86; P=.02) and cardiac events (relative risk for male sex, 1.67; 95{\%} CI, 1.24-2.26; P<.001). Among persons with documented CAD, no sex difference in outcome was noted. Conclusion: These population-based data indicate that, when the diagnosis of CAD was not established, there was a greater use of angiography among men with positive stress test results, which could be attributed to the increased probability of CAD in men. In the absence of documented CAD, men fared worse than women, with an increase in the risk of death and cardiac events. Among persons with documented CAD, no sex difference in use of angiography and outcome was noted.",
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AU - Roger, Veronique Lee

AU - Jacobsen, Steven J.

AU - Weston, Susan A.

AU - Pellikka, Patricia

AU - Miller, Todd D.

AU - Bailey, Kent R

AU - Gersh, Bernard J.

PY - 2002

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N2 - Objective: To examine sex differences in evaluation and outcome after stress testing for coronary artery disease (CAD) in a geographically defined cohort. Subjects and Methods: Subjects were residents of Olmsted County, Minnesota, who underwent an initial stress test between January 1, 1987, and December 31, 1990. End points included referral for coronary angiography, death, and cardiac events, defined as cardiac death, nonfatal myocardial infarction, or congestive heart failure. Results: A total of 2276 men and 1270 women underwent stress tests. Women were older and had more risk factors and comorbidities (P<.05). Among persons without documented CAD (86% of the cohort), the median probability of CAD was 11% (interquartile range, 5%-25%) for men and 8% (interquartile range, 2%-31%) for women (P<.001). Within 6 months after stress testing, 9% of men and 7% of women underwent coronary angiography. Among persons without documented CAD, there was no sex difference in referral for angiography when the stress test result was negative. When the test result was positive, men were more likely to be referred for angiography (adjusted odds ratio [OR] for male sex, 2.02; 95% confidence interval [CI], 1.21-3.38; P=.008). After adjusting for the predicted probability of CAD, this association was no longer detected (adjusted OR for male sex, 0.67; 95% CI, 0.26-1.73; P=.41). Among persons with documented CAD, no sex difference was noted. After a mean ± SD follow-up of 7.6±2.7 years and among persons without documented CAD, male sex was associated with a higher adjusted risk of death (relative risk for male sex, 1.40; 95% CI, 1.05-1.86; P=.02) and cardiac events (relative risk for male sex, 1.67; 95% CI, 1.24-2.26; P<.001). Among persons with documented CAD, no sex difference in outcome was noted. Conclusion: These population-based data indicate that, when the diagnosis of CAD was not established, there was a greater use of angiography among men with positive stress test results, which could be attributed to the increased probability of CAD in men. In the absence of documented CAD, men fared worse than women, with an increase in the risk of death and cardiac events. Among persons with documented CAD, no sex difference in use of angiography and outcome was noted.

AB - Objective: To examine sex differences in evaluation and outcome after stress testing for coronary artery disease (CAD) in a geographically defined cohort. Subjects and Methods: Subjects were residents of Olmsted County, Minnesota, who underwent an initial stress test between January 1, 1987, and December 31, 1990. End points included referral for coronary angiography, death, and cardiac events, defined as cardiac death, nonfatal myocardial infarction, or congestive heart failure. Results: A total of 2276 men and 1270 women underwent stress tests. Women were older and had more risk factors and comorbidities (P<.05). Among persons without documented CAD (86% of the cohort), the median probability of CAD was 11% (interquartile range, 5%-25%) for men and 8% (interquartile range, 2%-31%) for women (P<.001). Within 6 months after stress testing, 9% of men and 7% of women underwent coronary angiography. Among persons without documented CAD, there was no sex difference in referral for angiography when the stress test result was negative. When the test result was positive, men were more likely to be referred for angiography (adjusted odds ratio [OR] for male sex, 2.02; 95% confidence interval [CI], 1.21-3.38; P=.008). After adjusting for the predicted probability of CAD, this association was no longer detected (adjusted OR for male sex, 0.67; 95% CI, 0.26-1.73; P=.41). Among persons with documented CAD, no sex difference was noted. After a mean ± SD follow-up of 7.6±2.7 years and among persons without documented CAD, male sex was associated with a higher adjusted risk of death (relative risk for male sex, 1.40; 95% CI, 1.05-1.86; P=.02) and cardiac events (relative risk for male sex, 1.67; 95% CI, 1.24-2.26; P<.001). Among persons with documented CAD, no sex difference in outcome was noted. Conclusion: These population-based data indicate that, when the diagnosis of CAD was not established, there was a greater use of angiography among men with positive stress test results, which could be attributed to the increased probability of CAD in men. In the absence of documented CAD, men fared worse than women, with an increase in the risk of death and cardiac events. Among persons with documented CAD, no sex difference in use of angiography and outcome was noted.

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