March 13, 2010 (Atlanta, Georgia) — Women were twice as likely as men to be referred for cardiac catheterization in a new study.

"There appears to have been a paradigm shift in the way cardiologists refer to the cath lab," lead investigator, Dr Marcelo Di Carli (Brigham and Women's Hospital, Boston, MA) commented.

Presenting the data at a press conference today at the American College of Cardiology 2010 Scientific Sessions, Di Carli explained that in the past men have been consistently much more likely than women to be sent to the cath lab, but in recent years there has been increased publicity about the underrecognition of heart disease in women and campaigns to raise awareness. 'We wanted to look at this issue again in a contemporary study," he commented.

"It seems that the pendulum has swung in the opposite direction and, at this time, men appear to be treated at a lower frequency than women with respect to referral to cardiac catheterization after noninvasive cardiovascular imaging tests," he added.

Study participants were recruited from the Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in CAD (SPARC) registry. The current study involved 1700 US patients with no history of heart disease who had presented with chest pain and undergone cardiovascular imaging tests. These tests were abnormal in 30% of women and 22% of men. Overall, 10% patients in the study cohort were referred to cardiac catheterization within 90 days, with higher rates in women than men (13% vs 6%). After adjustment for age, diabetes, test result, type of imaging test, and chest pain, female sex remained a significant predictor of referral to cardiac catheterization.

"Overall there were 163 angiograms performed and 108 patients went on to receive revascularization. That is two-thirds of those who underwent angiography. I would assume that is an appropriate figure," he commented. "Without a definitive standard of appropriateness for referral to cardiac catheterization in patients after noninvasive testing, it is unclear whether the observed variation in referral to catheterization reflects undertreatment, appropriate use, or overtreatment," Di Carli said. Whether the difference in referrals by gender is due to excessive referral to cardiac catheterization in women or underutilization in men requires further investigation, he added.

To heartwire , Di Carli said he did not think this observation of a higher cath referral for women than men was an outlying result. "The registry is geographically diverse, multicenter, and includes both private practice and academic centers, so it should be representative of physicians practicing in this country."

He added: "In the past, symptoms of suspected heart disease in women have often been dismissed as false positives or misinterpreted. But things now seem to be changing, and there appears to be heightened awareness that chest pain in women could actually be symptoms of heart disease."


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