Significance of silent myocardial ischemia during exercise testing in women: Report from the Coronary Artery Surgery Study

To evaluate the significance of silent myocardial ischemia during exercise testing in women compared to men, we analyzed the data on 1087 women and 3834 men who underwent exercise testing and coronary angiography from the Coronary Artery Surgery Study (CASS) registry. The patients were divided into three groups on the basis of the results of exercise testing: group 1 silent ischemia (253 women, 853 men); group 2, symptomatic ischemia (156 women, 1250 men); and group 3, no ischemia (678 women, 1731 men). The survival rate at 12 years for women was 80% for group 1, 75% for group 2, and 86% for group 3 (p = 0.0022); the survival rate for men was 69% for group 1, 69% for group 2, and 76% for group 3 (p < 0.001). In both men and women with silent ischemia, the 12-year survival rate was related to the severity of coronary artery disease (CAD) and ranged from 79% for women with one-vessel CAD to 46% for men with three-vessel CAD. Survival at 12 years was enhanced by coronary artery bypass graft surgery as compared to medical treatment in patients with silent ischemia and three-vessel CAD for men (61% vs 46%, respectively, p = 0.0014) but not for women (45% vs 50%, respectively, p = 0.98). These data suggest that silent ischemia in women and men adversely affects survival rate and that men may gain more benefit from coronary artery bypass graft surgery than women when three-vessel CAD is present.