Defining Risk in Women

Certain gender differences can impact the diagnosis and prognosis of CAD in women:

• Clinical risk factors and chest pain symptoms have different predictive values in women compared with men.¹²
   
• Women present with CHD approximately 10 years later than men.⁶
   
• Exercise ECG in women can be highly variable and may be influenced by several factors, including:^6,9,64
• Exercise capacity
• Hormonal status
• Smaller blood vessels
   

Testing to Define CAD Risk

• The revised ACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Imaging recognized the gender-related issues in exercise stress testing and potential additive benefits of stress perfusion imaging in women.⁶⁵
   
• A new AHA scientific statement focusing on noninvasive cardiac testing in women stated, "Myocardial perfusion imaging has been shown in a multitude of clinical studies including 15,000 women to have powerful predictive value with regard to the development of subsequent cardiac death or MI or the need for coronary revascularization."⁷
   
• In recent recommendations from the ASNC Task Force on Women and Heart Disease⁹:
• Stress MPI is recommended for risk stratification of women with known or suspected CAD.
• Women incapable of performing 5 metabolic equivalents (METs) of exercise may be considered candidates for MPI with pharmacologic stress.⁹ (Five METs is the equivalent of moderate exercise such as bicycling, modest hiking, tennis, or lifting free weights.⁶⁶)
• According to Mieres et al, approximately 40% of women referred for MPI studies are candidates for pharmacologic stress testing.⁹