Symptom Presentation among Women with Suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA)
Identifying ischemic heart disease (IHD) in women based on symptoms is challenging. Women are more likely to endorse non-cardiac symptoms. More than 50% of women with suspected ischemia have no obstructive coronary disease (and thus, INOCA) and impaired outcomes during follow-up. We aimed to identif...
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| Format: | Article |
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MDPI AG
2023-09-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/18/5836 |
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| author | Yasmeen K. Taha Jennifer R. Dungan Michael T. Weaver Ke Xu Eileen M. Handberg Carl J. Pepine C. Noel Bairey Merz |
| author_facet | Yasmeen K. Taha Jennifer R. Dungan Michael T. Weaver Ke Xu Eileen M. Handberg Carl J. Pepine C. Noel Bairey Merz |
| author_sort | Yasmeen K. Taha |
| collection | DOAJ |
| description | Identifying ischemic heart disease (IHD) in women based on symptoms is challenging. Women are more likely to endorse non-cardiac symptoms. More than 50% of women with suspected ischemia have no obstructive coronary disease (and thus, INOCA) and impaired outcomes during follow-up. We aimed to identify symptoms having predictive capacity for INOCA in women with clinical evidence of coronary ischemia. We included 916 women from the original WISE cohort (NCT 00000554) who had coronary angiography performed for suspected ischemia and completed a 65-item WISE symptom questionnaire. Sixty-two percent (<i>n</i> = 567) had suspected INOCA. Logistic regression models using a best subsets approach were examined to identify the best predictive model for INOCA based on Score χ<sup>2</sup> and AICc. A 10-variable, best-fit model accurately predicted INOCA (AUC 0.72, 95% CI 0.68, 0.75). The model indicated that age ≤ 55 years, left side chest pain, chest discomfort, neck pain, and palpitations had independent, positive relationship (OR > 1) to INOCA (<i>p</i> < 0.001 to 0.008). An inverse relationship (OR < 1) was observed for impending doom, and pain in the jaw, left or bilateral arm, and right hand, interpreted as INOCA associated with the absence of these symptoms (<i>p</i> ≤ 0.001 to 0.023). Our best-fit model accurately predicted INOCA based on age and symptom presentation ~72% of the time. While the heterogeneity of symptom presentation limits the utility of this unvalidated 10-variable model, it has promise for consideration of symptom inclusion in future INOCA prediction risk modeling for women with evidence of symptomatic ischemia. |
| first_indexed | 2024-03-10T22:37:36Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T22:37:36Z |
| publishDate | 2023-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-cebf516bd47942958e526c5f9cc7c53b2023-11-19T11:18:03ZengMDPI AGJournal of Clinical Medicine2077-03832023-09-011218583610.3390/jcm12185836Symptom Presentation among Women with Suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA)Yasmeen K. Taha0Jennifer R. Dungan1Michael T. Weaver2Ke Xu3Eileen M. Handberg4Carl J. Pepine5C. Noel Bairey Merz6College of Medicine, University of Florida, 1600 Southwest Archer Road, Gainesville, FL 32610, USACollege of Medicine, University of Florida, 1600 Southwest Archer Road, Gainesville, FL 32610, USACollege of Nursing, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USADepartment of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32611, USACollege of Medicine, University of Florida, 1600 Southwest Archer Road, Gainesville, FL 32610, USACollege of Medicine, University of Florida, 1600 Southwest Archer Road, Gainesville, FL 32610, USABarbra Streisand Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USAIdentifying ischemic heart disease (IHD) in women based on symptoms is challenging. Women are more likely to endorse non-cardiac symptoms. More than 50% of women with suspected ischemia have no obstructive coronary disease (and thus, INOCA) and impaired outcomes during follow-up. We aimed to identify symptoms having predictive capacity for INOCA in women with clinical evidence of coronary ischemia. We included 916 women from the original WISE cohort (NCT 00000554) who had coronary angiography performed for suspected ischemia and completed a 65-item WISE symptom questionnaire. Sixty-two percent (<i>n</i> = 567) had suspected INOCA. Logistic regression models using a best subsets approach were examined to identify the best predictive model for INOCA based on Score χ<sup>2</sup> and AICc. A 10-variable, best-fit model accurately predicted INOCA (AUC 0.72, 95% CI 0.68, 0.75). The model indicated that age ≤ 55 years, left side chest pain, chest discomfort, neck pain, and palpitations had independent, positive relationship (OR > 1) to INOCA (<i>p</i> < 0.001 to 0.008). An inverse relationship (OR < 1) was observed for impending doom, and pain in the jaw, left or bilateral arm, and right hand, interpreted as INOCA associated with the absence of these symptoms (<i>p</i> ≤ 0.001 to 0.023). Our best-fit model accurately predicted INOCA based on age and symptom presentation ~72% of the time. While the heterogeneity of symptom presentation limits the utility of this unvalidated 10-variable model, it has promise for consideration of symptom inclusion in future INOCA prediction risk modeling for women with evidence of symptomatic ischemia.https://www.mdpi.com/2077-0383/12/18/5836symptomswomenfemalecoronary ischemiaINOCAno obstructive CAD |
| spellingShingle | Yasmeen K. Taha Jennifer R. Dungan Michael T. Weaver Ke Xu Eileen M. Handberg Carl J. Pepine C. Noel Bairey Merz Symptom Presentation among Women with Suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA) Journal of Clinical Medicine symptoms women female coronary ischemia INOCA no obstructive CAD |
| title | Symptom Presentation among Women with Suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA) |
| title_full | Symptom Presentation among Women with Suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA) |
| title_fullStr | Symptom Presentation among Women with Suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA) |
| title_full_unstemmed | Symptom Presentation among Women with Suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA) |
| title_short | Symptom Presentation among Women with Suspected Ischemia and No Obstructive Coronary Artery Disease (INOCA) |
| title_sort | symptom presentation among women with suspected ischemia and no obstructive coronary artery disease inoca |
| topic | symptoms women female coronary ischemia INOCA no obstructive CAD |
| url | https://www.mdpi.com/2077-0383/12/18/5836 |
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