Coronary disease & ACS

Sex differences in coronary disease health Status outcomes: the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial

Eur Heart J Qual Care Clin OutcomesPublished randomized

Primary result · Baseline SAQ-summary scoreResult — go to the resultDifference 6.5 points 95% CI 5.2–7.8

Authors' conclusion

Women with chronic CAD in ISCHEMIA had worse angina-related health status than men at baseline and 1-year. Differences were not explained by demographic or clinical characteristics, intensity of GDMT, or completeness of revascularization. It is thus important to consider other factors that may mediate these results, including differences in nociception, coronary microvascular dysfunction, and/or vasospasm.

Study context

Population
Patients with chronic coronary artery disease (CAD) and moderate or severe ischaemia in the ISCHEMIA trialISCHEMIA participants with complete Seattle Angina Questionnaire (SAQ) data
Participants
4,617 patients
Comparison
Women vs men: angina-related health status at baseline and 1-year

Primary result

Baseline SAQ-summary score

Difference

6.5 points

95% CI 5.2–7.8

Womenvs Men
difference 6.5 points (95% CI 5.2–7.8)

As reported in the abstract

Further findings

OutcomeDifference (points)
Unadjusted 1-year SAQ-SS, women vs menWomen vs Men · Invasive strategy; lower in women−3.8
Unadjusted 1-year SAQ-SS, women vs menWomen vs Men · Conservative strategy; lower in women−5.7

Unadjusted 1-year SAQ-SS, women vs men

Sex-based differences attenuated but not eliminated by adjustment for baseline SAQ-SS
Adjustment for post-randomization treatment (guideline-directed medical therapy (GDMT) intensity, risk factor goal achievement and, in the invasive strategy, complete revascularization) did not narrow the sex difference

Original publication

Sex differences in coronary disease health Status outcomes: the ISCHEMIA trial. Eur Heart J Qual Care Clin Outcomes. Published 13 April 2026. doi:10.1093/ehjqcco/qcag052

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