EURO PEAN SOCI ETY OF CARDIOLOGY ® Original scientific paper No gender difference in the extent of myocardial ischemia in non-ST elevation myocardial infarction Mai T Lønnebakken 1,2 , Jan E Nordrehaug 1,2 and Eva Gerdts 1,2 Abstract Background: Significant gender differences in angiographic severity of coronary artery disease (CAD) have been demonstrated among patients with non-ST-elevation myocardial infarction (NSTEMI). However, it is unknown if these gender differences are reflected in the extent of myocardial ischemia. Design and methods: We assessed segmental myocardial wall motion and perfusion by contrast echocardiography in 110 patients (34 women and 76 men) with NSTEMI prior to scheduled coronary angiography. The extent of myocardial ischemia using a 17-segment left ventricular (LV) model was compared to quantitative coronary angiography (QCA). Results: Age (70  12 vs 66  12 years), troponin T level (0.53  0.66 vs 0.75  1.32 mg/l), Thrombolysis In Myocardial Infarction (TIMI) risk score (3.2  1.4 vs 3.5  1.4), LV ejection fraction and cardiovascular risk factor burden did not differ between genders. As expected, women had less severe findings on coronary angiography but the extent of myocardial ischemia by contrast echocardiography was comparable in women and men. In multivariable analysis, the risk of having prognostically severe angiographic CAD increased by 29% in women and by 49% in men for every additional LV segment with ischemia, independent of TIMI risk score (both p < 0.01). Conclusion: The present contrast echocardiography study in NSTEMI patients demonstrates that women with NSTEMI have the same extent of LV myocardial ischemia as men in spite of less prevalent angiographic CAD. The findings may help explain why less severe angiographic findings in women with NSTEMI are not accompanied by lower mortality. Keywords Gender, myocardial ischemia, contrast echocardiography, non-obstructive ischemic heart disease, non-ST elevation myocardial infarction Received 9 February 2012; accepted 18 June 2012 Introduction Previous studies have demonstrated that although women with non-ST elevation myocardial infarction (NSTEMI) have less obstructive coronary artery disease (CAD), there is no significant difference in age-adjusted mortality between men and women. 1–7 Typically, women with NSTEMI have a higher burden of cardiovascular risk factors, including hyper- tension, diabetes and obesity which may influence myocardial perfusion independent of coronary artery stenosis, underlining the potential prognostic benefit from aggressive risk factor modulation in women with NSTEMI. 7,8 Increased incidence of abnormal coronary reactivity, microvascular dysfunction and plaque ero- sion with distal micro-embolization may explain the higher prevalence of normal or non-obstructive findings on coronary angiograms in women with NSTEMI. Recently, it was demonstrated that non-obstructive ischemic heart disease by coronary angiographic com- puter tomography predicted increased mortality in women with stable angina pectoris, but not in men. 9 From previous publications it may be hypothesized that angiographic CAD better reflects the extent of 1 Institute of Medicine, University of Bergen, Norway 2 Department of Heart Disease, Haukeland University Hospital, Norway Corresponding author: Mai T Lønnebakken, Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway Email: Mai.Lonnebakken@med.uib.no European Journal of Preventive Cardiology 2014, Vol 21(1) 123–129 ! The European Society of Cardiology 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2047487312454107 ejpc.sagepub.com by guest on February 7, 2016 cpr.sagepub.com Downloaded from