Martha Gulati, MD

“Gender differences and temporal trends after stress testing”

Differences in cardiac care based on gender have been described for over 20 years. As early as 1987, it was reported that 40% of male patients with an abnormal exercise radionucleotide test were referred for cardiac catheterization, in contrast with only 4% of the female patients.  It currently remains unknown whether potential inequities in the management of cardiovascular disease have consequences in terms of prognosis.  Since this initial description, numerous other studies have continued to show a less aggressive management strategy for coronary artery disease (CAD) in women compared with men. Gender differences in coronary catheterization referral have been demonstrated in a number of other studies, but the implications of the gender inequities are not clear. Certainly, the prevalence and presentation of CAD differs according to gender. In addition, the utilization and diagnostic value of stress tests differ according to gender as well. These all influences the referral patterns for coronary angiography after stress testing, when the diagnosis of CAD is not established.  It is unclear if these gender differences are due to overutilization of angiography in men, underutilization in women, or appropriate sex-specific utilization. A number of studies to date have repeatedly confirmed the underutilization of angiography in women, after an abnormal stress test or symptoms of angina, but this has not always translated into better outcomes for men. No study to date has described the change in referral patterns over time for angiography and revascularization based on abnormal stress testing and how this affects mortality. The goal of this pioneer award is to analyze the referral patterns for coronary angiography after any abnormal nuclear stress test, for both men and women, and determine is implications on mortality based on gender.