Background Female patients with chest pain pose unique problems to clinicians. Traditionally, epidemiological evidence has demonstrated low sensitivity and specificity in physiologic stress testing leading to poor accuracy in the ability of these tests to predict coronary artery disease (CAD) among women with chest pain We evaluated the accuracy of clinical symptoms, dobutamine stress echo (DSE) and nuclear stress testing (NST) in predicting presence of CAD among women presenting with chest pain in a large, tertiary referral center.
Methods We evaluated 30 female patients that have undergone cardiac catheterization within the past two years. These patients proceeded to cath after having a positive DSE, NST or due to strong clinical suspicion. Patients with acute myocardial infarction, planned valvular surgery or coronary bypass were excluded from statistical analyses. Presence of CAD was defined as any stenotic lesions greater than 50% of coronary luminal diameter. Differences among groups were analyzed by ANOVA, paired and unpaired Student's t tests for significance. Data reported as percent accuracy.
Results All patients underwent cardiac catherization as a result of strong clinical suspicion, positive DSE or nuclear stress myocardial imaging. The accuracy of DSE in predicting presence of CAD is 67%, significantly (P≤ 0.05) higher than nuclear stress myocardial imaging (accuracy = 18%). There was a trend towards a significant difference between DSE and clinical suspicion in predicting presence of CAD, (67% vs. 42%, P = NS). Clinical suspicion is more accurate than nuclear stress imaging in predicting CAD (42% vs. 18%, P ≤ 0.05).
Conclusions Female patients with chest pain pose unique problems to clinicians. From our single center study, the data demonstrate that DSE is superior to clinical suspicion and nuclear stress imaging in accurately predicting presence of CAD among women presenting with chest pain.
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