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 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 (n = 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 chi(2) 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 (p < 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 (p <= 0.001 to 0.023). Our best-fit model accurately predicted INOCA based on age and symptom presentation similar to 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.

Automated summary

Identifying ischemic heart disease (IHD) in women based on symptoms is challenging, as women are more likely to experience non-cardiac symptoms. More than 50% of women with suspected ischemia have no obstructive coronary disease, leading to impaired outcomes during follow-up. A study aimed to identify symptoms that can predict non-obstructive coronary artery disease (INOCA) in women with clinical evidence of coronary ischemia. The study found that age, left side chest pain, chest discomfort, neck pain, and palpitations had a positive relationship with INOCA, while impending doom and pain in the jaw, left or bilateral arm, and right hand were inversely related to INOCA. The best-fit model accurately predicted INOCA based on age and symptom presentation about 72% of the time.