LAUSR

We recently came across a very interesting article published in the Indian Heart Journal“Development of a diagnosis model for coronary artery disease” by Hongzeng Xu et al.. It was a retrospective multi-centric study, in which authors have evaluated risk factor and angiographic profile of 7360 Chinese patients with suspected coronary artery disease (CAD). Using this data, they developed a prediction model including age, sex, and cardiovascular risk factors that was found to be highly accurate for the estimation of the pre-test probability of coronary artery disease. CAD continues to be the leading cause of death in both men and women worldwide. However, CAD in women presents a unique and complex challenge to the clinicians. They often have larger symptom burden and more atypical presentation, yet lower rates of obstructive CAD compared to similarly aged men. Exercise ECG stress test has a very limited accuracy in women especially because of the resting ST-T wave changes, lower ECG voltage and certain hormonal factors. Similar to TMT, other common observations like electrocardiographic changes, myocardial perfusion defects, and regional wall motion abnormalities have limited predictive value in women undergoing evaluation for CAD. Furthermore, the use of CT coronary angiography is limited and expansive especially in a developing country like India. Coronary angiography (CAG) continues to be the gold standard investigation for diagnosis of obstructive CAD. But whether we can recommend it as a first line investigation to all the women presenting with chest pain, especially those with atypical chest painthe answer is definitely ‘No’. This is because CAG is an invasive modality with inherent risk of complications. Although generally considered safe, death and procedural myocardial infarction can occur as complications in 0.1% patients. Vascular site complications are more frequently observed in as high as 8% patients depending upon the operator’s expertise, and occur more frequently in women. Therefore for all these reasons, it is imperative to identify the predictors of obstructive CAD in women before they undergo invasive coronary angiography. With this aim, we conducted a prospective study in 674 consecutive female patients with suspected CAD, who underwent coronary angiography in our institute over a two years’ period (2015–2016). Risk factor profile and angiographic pattern of disease were recorded systematically in each patient. Obstructive CAD was defined as the presence of at least one major epicardial coronary artery with 50% or more narrowing of the luminal diameter. Patients were divided into 2 groups, with and without