MODELS FOR IDENTIFYING OBSTRUCTIVE CORONARY ARTERY DISEASE

Abstract

Heart disease is the leading cause of death for both men and women. However, women have a unique coronary heart disease (CHD) phenotype, with fewer calcified lesions and more non-obstructive plaque. This may partly explain why risk models for obstructive CHD in men may not accurately predict the risk of CHD for women. This article summarizes the differences in functional and anatomical assessments of CHD between men and women with stable chest pain. It also proposes an approach for using multimodal imaging to evaluate women with suspected CHD, based on recent American Heart Association (AHA) guidelines.A paradigm shift is needed in the approach to imaging women with coronary artery disease (CAD), including updated risk models, a better understanding of CAD in women, in whom non-obstructive disease is more common. Algorithms focused on the assessment of ischemia in non-obstructive CAD and myocardial infarction in women with non-obstructive CAD are also needed.