Assessment of Estrogen Status as a Marker of Prognosis in Women With Symptoms of Suspected Coronary Artery Disease Presenting for Stress Testing

Estrogen status (ES) has previously been shown to be a marker of angiographic outcome in women. In light of this finding, a reevaluation of ES as a marker of prognosis was undertaken. Two thousand one hundred forty-three women who underwent stress testing for symptoms of suspected coronary disease were studied. ES was defined according to menopausal, ovarian, and hormone replacement therapy status. The end points of interest were all-cause mortality, cardiac death, and nonfatal myocardial infarction. Survival analysis was performed using the Kaplan-Meier method and Cox regression analysis with censoring at revascularization. Compared with 1,362 ES-positive women, the 781 ES-negative women had a higher frequency of unfavorable end points (all-cause death: ES positive 31 [2.3%] vs ES negative 94 [12%], p <0.0001, cardiac death: ES positive 11 [0.8%] vs ES negative 38 [4.9%], p <0.0001, and nonfatal myocardial infarction: ES positive 11 [0.8%] vs ES negative 17 [2.2%], p = 0.007). The Kaplan-Meier curve analysis indicated that ES was a marker of cardiac risk (p <0.0001) in all women, as well as in postmenopausal women. Multivariate Cox regression analysis revealed that ES was an independent marker of risk (p <0.001) when considered with other standard risk factors. Using logistic regression and area under the curve analyses, ES had incremental value compared with standard risk factors. In conclusion, ES appears to be an easily discernible independent marker of risk that provides incremental prognostic information compared with standard clinical variables in women with symptoms of suspected coronary disease presenting for stress testing.