Liaqat Ali, Shakeel-ur Rehman, Rehan Riaz, Imtiaz Ahmed.
Prevalence of Coronary Artery Disease in Young Women Undergoing Elective Cardiac Catheterization: Role of Pre – Invasive Workup.
Ann Pak Inst Med Sci Jan ;11(2):72-7.

Objective: To study the prevalence of significant CAD in young women (≤50 years) undergoing elective coronary angiography and to discuss the role of non invasive modalities to assess CAD in female. Study design: Cross sectional study. Place and Duration: The study was conducted at Faisalabad Institute of Cardiology, Faisalabad from August 2010 to April 2011. Material and Method: Total 3319 patients underwent coronary angiography during the study period. 857 (25.82%) were female. Out of these 857 female patients, 200 consecutive patients who fulfill the inclusion and exclusion criteria were enrolled in the study. A full history including age, sex, occupation, history of IHD, hypertension, diabetes mellitus, smoking, family history of IHD, obesity and hperlipidemia was taken. ECG of every patient was done. Records of other non invasive investigations were noted. After coronary angiography patients were divided into two groups with and without CAD. Numbers of risk factors were correlated with number of vessels involved in disease and were compared in both groups. Results: Total 3319 patients underwent diagnostic catheterization during study period. 200 female patients who fulfill the inclusion and exclusion criteria were enrolled in the study. Mean age was 43.9, SD ± 5.644 years. Majority of the patients 102(51%) were in age group 35-46 years. There were 140 (70%) hypertensive, 72 (36%) diabetics. Family history of IHD was present in 72(36%). 86(43%) patients presented with typical angina symptom, resting ECG shows ischemic changes in only 60(30%) patients. Echocardiography was performed in 34(17%) patients. ETT and stress Thallium only in 10 % and 1% respectively. Diabetes was more common 68% in patients with CAD compared with patients without CAD 25% (68% vs. 25% ≤ 0.001). 75% of the patients had normal coronary angiography while significant CAD was identified in only 25%. Significant left main stem stenosis was found in 4/50(8%) patients. A normal coronary angiogram was inversely related to the number of risk factors for CAD. Conclusions: The prevalence of CAD is low among young women age ≤ 50 years undergoing elective coronary angiography. CAD in women represents an important problem that is difficult to identify early. The atypical presentation, the unique risk factors and more frequent normal coronaries on angiography should be kept in mind. More research is needed to explore these sex-related differences so that optimal gender specified diagnostic and management strategies can be developed.

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