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Risk stratification in unstable coronary artery disease: Exercise test and troponin T from a gender perspective
Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-2608-2062
Department of Cardiology, University of Uppsala, Uppsala, Sweden.
2000 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 35, no 7, 1791-1800 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES

The study was done to determine the prognostic yield of an early symptom-limited exercise test (ET) and measurement of troponin T (TnT) in men and women with unstable coronary artery disease (CAD), with special reference to gender differences.

BACKGROUND

Early risk assessment is essential for the application of appropriate treatment and further management in patients with unstable CAD. The early symptom-limited ET together with specific biochemical marker determination is an inexpensive, widely applicable method for early risk stratification. In women, however, the ET is considered less reliable, and there are few data on biochemical markers for risk stratification in women.

METHODS

In a substudy of the Fragmin during InStability in Coronary artery disease (FRISC I) trial, 395 women and 778 men with unstable CAD who performed an early ET were followed for six months. Blood samples for TnT determination were taken in 342 women and 621 men at inclusion.

RESULTS

Based on the ET results, low-, intermediate-, and high-risk response groups were identified with event rates of cardiac death or myocardial infarction (MI) of 1%, 9%, and 19%, respectively, among women and 8%, 14%, and 20%, respectively, among men. Patients who could not perform the ET had an event rate similar to the high-risk group. The TnT levels were divided into three groups: <0.06, 0.06–0.19, and ≥0.20 μg/liter with event rates of 1%, 10%, and 18%, respectively, among women and 9%, 14%, and 18%, respectively, among men. Combining the ET results with TnT levels identified a low-risk group with an event rate of 3% in the male population and no events in the female population.

CONCLUSIONS

Direct comparison between men and women from the same population with a high pretest likelihood of disease suggests that both TnT and the early symptom-limited ET are at least as useful as prognostic risk indicators in women as they are in men.

Place, publisher, year, edition, pages
2000. Vol. 35, no 7, 1791-1800 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-27170DOI: 10.1016/S0735-1097(00)00655-0Local ID: 11819OAI: oai:DiVA.org:liu-27170DiVA: diva2:247721
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Diagnostic and Prognostic Evaluation in Postmenopausal Women with Signs and Symptoms of Unstable Coronary Artery Disease
Open this publication in new window or tab >>Diagnostic and Prognostic Evaluation in Postmenopausal Women with Signs and Symptoms of Unstable Coronary Artery Disease
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Coronary artery disease (CAD) is the major cause of death in both men and women in the western world. The majority of studies undertaken to evaluate diagnostic methods, risk stratification and treatment of CAD, have been performed on men. Although there are studies reporting gender differences in the presentation of symptoms, prognosis and response to treatment, current recommendations for practice are based on a model of the disease in men.

The diagnostic information from basic clinical data, ECG and an early symptomlimited exercise test was evaluated in a prospective study on 200 postmenopausal women with unstable CAD. The prevalence of atherosclerosis was high (85%). A patient history and markers of myocardial injury were good predictors of significant CAD and the exercise test was as valuable for the assessment of this diagnosis in women as that reported in men.

The incremental diagnostic values of basic clinical data, the exercise test and 201TI SPECT were assessed in 121 postmenopausal women after an episode of unstable CAD. There was an incremental diagnostic value of 201TI SPECT compared to basic data and the exercise test when diagnosing significant CAD, but not regarding the identification of extensive CAD.

Evaluation of symptom-limited exercise test for risk stratification in postmenopausal women with unstable CAD was carried out on a population of 395 women in the "FRagmin during InStability in CAD" (FRISC I) Study. The exercise test was a good predictor of future cardiac death and myocardial infarction (MI) if parameters reflecting cardiac performance also were taken under consideration and not only chest pain and ST-segment depression, two parameters reflecting ischaemia and often used in studies on men. However, the patients who, after admission, did not become stable enough to perform the exercise test, had the highest risk of adverse future events.

Comparison of symptom limited exercise test and troponin T measurements for risk stratification in women and men was performed in the FRISC I study population. It was concluded that the early symptom-limited exercise test and troponin T are at least as useful as prognostic risk indicators in women as they are in men.

The gender differences in outcome after early revascularisation compared to noninvasive management was assessed in 749 women and 1708 men in the "Fast Revascularisation during InStability in CAD" (FRISC II) Study. Women were older, had less severe CAD and a better prognosis than men. Men had a more favourable outcome if randomised to early revascularisation, whereas there was an opposite trend in women, although not significant. The different outcome in women may partly be explained by A high procedure-related event rate in the invasive group compared to the non-invasive group, and an overall low event rate during follow-up. Further research is needed in this area, and in the mean time, a more conservative approach to revascularisation in women, guided by risk stratification seems reasonable.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2000. 110 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 647
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27546 (URN)12207 (Local ID)91-7219-748-X (ISBN)12207 (Archive number)12207 (OAI)
Public defence
2000-11-10, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-15Bibliographically approved

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Säfström, KågeSwahn, Eva

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