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Adverse outcomes among women presenting with signs and symptoms of ischemia and no obstructive coronary artery disease: findings from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) angiographic core laboratory.
Am Heart J 2013; 166(1):134-41AH

Abstract

BACKGROUND

Women presenting with signs and symptoms of myocardial ischemia frequently have no or nonobstructive coronary artery disease (CAD).

OBJECTIVE

This study aimed to investigate the associations between angiographic measures and longer-term clinical outcomes among women with signs and symptoms of ischemia referred for coronary angiography.

METHODS

A prospective cohort analysis of women referred for coronary angiography and enrolled in the National Heart, Lung, and Blood Institute-sponsored WISE was performed. An angiographic severity score was prospectively developed, assigning points for any stenosis weighted by stenosis severity, location, and collaterals and was then tested for prediction for adverse outcome in 917 women, over a median of 9.3 years.

SETTING

The study was conducted in referral centers.

PATIENTS

Women with signs and/or symptoms of myocardial ischemia referred for coronary angiography were consecutively consented and enrolled in a prospective study.

MAIN OUTCOME MEASURES

Main outcomes included first occurrence of cardiovascular death or nonfatal myocardial infarction. Hospitalization for angina was a secondary outcome.

RESULTS

Cardiovascular death or myocardial infarction at 10 years occurred in 6.7%, 12.8%, and 25.9% of women with no, nonobstructive, and obstructive CAD (P < .0001), respectively. Cumulative 10-year cardiovascular death or myocardial infarction rates showed progressive, near-linear increases for each WISE CAD severity score range of 5, 5.1 to 10, 10.1 to 20, 20.1 to 50, and >50. The optimal threshold in the WISE severity score classifications for predicting cardiovascular mortality was >10 (eg, 5.0-10 vs 10.1-89), with both a sensitivity and specificity of 0.64 and an area under the curve of 0.64 (P = .02, 95% CI 0.59-0.68).

CONCLUSIONS

Among women with signs and symptoms of ischemia, nonobstructive CAD is common and associated with adverse outcomes over the longer term. The new WISE angiographic score appears to be useful for risk prediction in this population.

Authors+Show Affiliations

Rhode Island Hospital, Providence, RI, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23816032

Citation

Sharaf, Barry, et al. "Adverse Outcomes Among Women Presenting With Signs and Symptoms of Ischemia and No Obstructive Coronary Artery Disease: Findings From the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) Angiographic Core Laboratory." American Heart Journal, vol. 166, no. 1, 2013, pp. 134-41.
Sharaf B, Wood T, Shaw L, et al. Adverse outcomes among women presenting with signs and symptoms of ischemia and no obstructive coronary artery disease: findings from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) angiographic core laboratory. Am Heart J. 2013;166(1):134-41.
Sharaf, B., Wood, T., Shaw, L., Johnson, B. D., Kelsey, S., Anderson, R. D., ... Bairey Merz, C. N. (2013). Adverse outcomes among women presenting with signs and symptoms of ischemia and no obstructive coronary artery disease: findings from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) angiographic core laboratory. American Heart Journal, 166(1), pp. 134-41. doi:10.1016/j.ahj.2013.04.002.
Sharaf B, et al. Adverse Outcomes Among Women Presenting With Signs and Symptoms of Ischemia and No Obstructive Coronary Artery Disease: Findings From the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) Angiographic Core Laboratory. Am Heart J. 2013;166(1):134-41. PubMed PMID: 23816032.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adverse outcomes among women presenting with signs and symptoms of ischemia and no obstructive coronary artery disease: findings from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) angiographic core laboratory. AU - Sharaf,Barry, AU - Wood,Todd, AU - Shaw,Leslee, AU - Johnson,B Delia, AU - Kelsey,Sheryl, AU - Anderson,R David, AU - Pepine,Carl J, AU - Bairey Merz,C Noel, Y1 - 2013/05/02/ PY - 2012/11/09/received PY - 2013/04/01/accepted PY - 2013/7/3/entrez PY - 2013/7/3/pubmed PY - 2014/5/3/medline SP - 134 EP - 41 JF - American heart journal JO - Am. Heart J. VL - 166 IS - 1 N2 - BACKGROUND: Women presenting with signs and symptoms of myocardial ischemia frequently have no or nonobstructive coronary artery disease (CAD). OBJECTIVE: This study aimed to investigate the associations between angiographic measures and longer-term clinical outcomes among women with signs and symptoms of ischemia referred for coronary angiography. METHODS: A prospective cohort analysis of women referred for coronary angiography and enrolled in the National Heart, Lung, and Blood Institute-sponsored WISE was performed. An angiographic severity score was prospectively developed, assigning points for any stenosis weighted by stenosis severity, location, and collaterals and was then tested for prediction for adverse outcome in 917 women, over a median of 9.3 years. SETTING: The study was conducted in referral centers. PATIENTS: Women with signs and/or symptoms of myocardial ischemia referred for coronary angiography were consecutively consented and enrolled in a prospective study. MAIN OUTCOME MEASURES: Main outcomes included first occurrence of cardiovascular death or nonfatal myocardial infarction. Hospitalization for angina was a secondary outcome. RESULTS: Cardiovascular death or myocardial infarction at 10 years occurred in 6.7%, 12.8%, and 25.9% of women with no, nonobstructive, and obstructive CAD (P < .0001), respectively. Cumulative 10-year cardiovascular death or myocardial infarction rates showed progressive, near-linear increases for each WISE CAD severity score range of 5, 5.1 to 10, 10.1 to 20, 20.1 to 50, and >50. The optimal threshold in the WISE severity score classifications for predicting cardiovascular mortality was >10 (eg, 5.0-10 vs 10.1-89), with both a sensitivity and specificity of 0.64 and an area under the curve of 0.64 (P = .02, 95% CI 0.59-0.68). CONCLUSIONS: Among women with signs and symptoms of ischemia, nonobstructive CAD is common and associated with adverse outcomes over the longer term. The new WISE angiographic score appears to be useful for risk prediction in this population. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/23816032/Adverse_outcomes_among_women_presenting_with_signs_and_symptoms_of_ischemia_and_no_obstructive_coronary_artery_disease:_findings_from_the_National_Heart_Lung_and_Blood_Institute_sponsored_Women's_Ischemia_Syndrome_Evaluation__WISE__angiographic_core_laboratory_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(13)00237-8 DB - PRIME DP - Unbound Medicine ER -