Cardiovascular Events in Women's Ischemia Syndrome Evaluation

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DESCRIPTION (provided by applicant): The Women's Ischemia Syndrome Evaluation (WISE) study has been a successful and productive four-center prospective study of women clinically referred for coronary angiography for evaluation of symptoms suggestive of ischemia. Its major aims were to improve diagnostic testing for ischemic heart disease and to explore female-specific ischemic heart disease pathophysiology. Initiated in September 1996, recruitment of 936 women was completed in a timely manner by March 2000. Support was awarded for an additional five years of follow-up, and our database was closed in March 2006. A rich longitudinal database on these women is available. We are seeking funding to perform a National Death Index (NDI) search to extend mortality follow-up to an average of eight years (maximum 10 years). Patient names reside at the clinical sites, but to maintain confidentiality, are not included in the WISE database at the coordinating center. Experienced site coordinators will prepare materials to submit to the NDI and send results to the coordinating center. Updated mortality data will be added to the WISE database and analyzed. We will evaluate demographic medical history factors, hormonal status, psychosocial results of baseline diagnostic testing and genetic factors as predictors of mortality. Extension of cardiovascular mortality data will more clearly define prognostic factors for long-term mortality in women with ischemia with and without obstructive disease. With an additional targeted analysis, we will develop a simple, reproducible, angiographic technique to identify micro-vascular dysfunction, by correlating TIMI Frame Count with Doppler Wire determined coronary flow reserve measured in response to adenosine in WISE women with suspected ischemia but no significant coronary artery disease. Availability of a simple diagnostic technique allows clinicians to target these women for aggressive medical therapy aimed at early coronary artery disease and improved prognosis. PUBLIC HEALTH RELEVANCE: Much attention has been focused on the differences between men and women presenting with heart attacks and angina pain. The Women's Ischemia Syndrome Evaluation (WISE) study has been a successful and productive prospective study of women clinically referred for coronary angiography for evaluation of symptoms suggestive of ischemia. The goals of WISE were to improve diagnostic testing for ischemic heart disease and to explore female-specific ischemic heart disease pathophysiology. A National Death Index (NDI) search will be used to extend mortality follow-up for WISE women to an average of eight years (maximum 10). Experienced site coordinators will prepare materials to submit to NDI and send results to the coordinating center where updated mortality data will be added to the WISE database and analyzed. Using our existing database, coronary risk factors, hormonal status, psychosocial, genetic factors, and results of diagnostic tests will be evaluated as predictors of long-term mortality. L:\WISE\WISE R03\FINAL\Narrative.doc