Background: Recent reports suggest sex-related differences in the management of patients with coronary artery disease.
Methods: This study examined the pattern of use of coronary angiography in 535 patients initially referred for adenosine single photon emission computed tomography (SPECT) thallium imaging.
Results: Coronary angiography was carried out more often in patients under 70 years of age than those over 70 years of age [107 out of 322 (33%) versus 50 out of 213 (23%), P < 0.01]. Even in patients with abnormal adenosine SPECT thallium results, coronary angiography was less frequently performed in the elderly [40 out of 130 (31%) versus 82 out of 178 (46%), P < 0.01]. Women underwent coronary angiography less often than men [56 out of 261 (21%) versus 101 out of 274 (37%), P < 0.0002]. This difference was due to differences in patients under 70 years of age [31 out of 138 women (22%) versus 76 of 184 men (41%), P < 0.003)], but not in patients over 70 years of age. In patients with abnormal adenosine thallium image results, the difference between men and women was still present: 37 out of 112 women (33%) versus 85 of 196 men (43%) underwent coronary angiography (P = 0.05). Stepwise discriminant analysis of clinical and scintigraphic variables identified four independent predictors of the need for coronary angiography; the abnormal thallium image results (chi 2 = 33, P < 0.0001); the size of the perfusion abnormality (chi 2 = 7, P < 0.01); sex (chi 2 = 7, P < 0.01) and age (chi 2 = 4, P < 0.05).
Conclusion: Coronary angiography is less often performed in women and elderly patients even when initial screening results are abnormal. The relation of this observation to subsequent clinical course and events requires further studies.