OBJECTIVES: Evidence suggests that women receive less coronary angiographies (CA) for suspected chronic coronary artery disease (CAD) than men. Little is known about whether these differences might be due to a lower care providers’ guideline adherence in female than in male patients, as suspected for example in the management of acute coronary syndrome. Therefore, this study investigated patient-related sex differences in providers’ guideline adherence for CA in chronic CAD.

METHODS: Based on data from the German ENLIGHT-KHK trial, patients with suspected CAD who received a CA were analyzed. To assess the association between guideline adherence and sex, binary logistic regression models were developed. Covariates included age, symptoms, risk factors, and comorbidities (model 2), and additionally non-invasive tests and their results (model 1). To examine sex differences in predictors of guideline adherence, models were also run separately for women and men.

RESULTS: Overall, 273 women and 386 men were included. They aged 67 (±10) years and 224 (34.0%) of them had a typical angina. Guideline adherence for CA was lower in women than in men (19.4% vs. 30.1%, p=0.002). Regression models identified sex as independent predictor of guideline adherence for CA, showing women to be less likely to receive adherent CA (model 1: OR 0.396, p=0.002; model 2: OR 0.443, p<0.001). Predictors of guideline adherence differed between women and men in that they included less variables on non-invasive testing and pre-test probability, but more risk factors and comorbidities in women. Model performance was remarkably higher when covariates included non-invasive tests and their results (model 1).

CONCLUSIONS: This analysis indicates that women with suspected CAD are less likely to receive guideline-adherent CA than men. Generating and disseminating sex-specific evidence on CAD could potentially reduce sex differences in guideline adherence for the diagnosis of chronic CAD.