982-68 Outcome Following Stress Testing: Are There Any Gender Related Differences? A Population Based Study

Gender differences in management after stress tests have been documented, possibly reflecting gender bias. Whether these differences impact on long-term outcome is not known but is critical to assess appropriateness of care. We conducted a retrospective population based cohort study of 604 persons (413 men, 191 women) who had a first stress test in 1987 in Olmsted County MN with complete follow up until 1994 or death. At study entry, women were older(55±17 years oldvs 48±14years old for men) and more likely to have typical angine (38% vs 29% of men), hypertension (37% vs 30% of men), a family history of coronary artery disease (72% vs 59% of men), and a positive stress test (19% vs 12% of men) (p<0.05). The frequency and relative risks (RR) of cardiac event (myocardial infarction, congestive heart failure cardiac death) with and without inclusion of revascularization (revasc) and overall death were:WomenMenRR95% CICardiac event14(7%)36(9%)0.80.4 to 1.5Cardiac event incl revasc18(9%)66(16%)0.50.3 to 0.9Overall death16(8%)19(5%)1.70.9 to 3.4After adjusting for history of myocardial infarction, symptoms, age, stress test results and comorbidity, no gender difference in risk of death was seen. Women with a negative stress test were at a lower risk of cardiac event (RR 0.4, 95% CI 0.16 to 1.0); when revascularization was included as cardiac event, the relative risk was lower in women than in men (RR 0.4, 95% CI 0.2 to 0.6).ConclusionThese population based data suggest that there is no excess risk of overall death, cardiac death or myocardial infarction in women. The risk of cardiac event including revascularization, however, was lower in women: this may represent underutilization of revascularization in women or overutilization in men