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Stress Tests Less Useful for Assessing Heart Disease in Women than Men

CardioSmart News

When it comes to assessing heart disease, imaging proves more useful than traditional stress tests in women, according to findings presented at the American College of Cardiology’s 65th Annual Scientific Sessions and published in the Journal of the American College of Cardiology.

This study analyzed data from the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), which assessed nearly 9,000 patients with chest pain. Through the trial, patients were randomly assigned to either stress tests or cardiac CT scans (computed tomography angiography), both of which are commonly used to diagnose heart disease. Stress tests help determine how well the heart handles its workload, while CT scans use imaging to assess the heart’s arteries. Researchers then followed participants for more than two years to see how well tests predicted future heart risk.

After comparing test results, researchers found that more women had positive stress test results than positive CT results. A positive test result indicates a diagnosis of heart disease. However, fewer women with positive stress tests went on to have a future heart event compared to women with positive imaging tests.

Men, on the other hand, were more likely to have a positive imaging test than stress test. Among men with positive results, risk for future heart events was similar regardless of which test was used.

Findings suggest that for women, imaging tests helped predict future heart events better than stress tests. Thus, their ability to predict cardiac risk should be considered when choosing diagnostic tests in women with chest pain. Authors also note that when results are positive, their ability to predict future events should be taken into consideration.

However, authors also note that findings don’t change current guidelines for assessing heart disease. Stress tests and imaging tests are both useful for assessing heart disease, and which test is most appropriate depends on the characteristics of each patient. But with future research, authors hope to explore sex differences in diagnostic tests and further refine guidelines for cardiac testing.

Read the full article in JACC: Cardiovascular Imaging. Learn about CardioSmart's editorial process. Information provided for educational purposes only. Please talk to your health care professional about your specific needs.