HERMES: Say Goodbye to Typical and Atypical Angina Terminology?

"The terms typical and atypical angina should be abandoned, as they do not correlate with disease and may perpetuate stereotypes based on sex," according to researchers presenting findings on the HERMES trial on Sept. 2 during ESC Congress 2019.

Catherine Kreatsoulas, MSc, PhD, et al., assessed 637 patients, of whom 40 percent were women and 60 percent were men and who were referred for their first coronary angiogram for suspected coronary artery disease with at least one prior abnormal test. Researchers captured the natural conversational exchange of the patient and physician, while a separate semi-structured interview was also audio recorded and transcribed verbatim. Machine learning and statistical models were used to characterize symptoms based on sex and obstructive disease.

Results found that women were less likely to have obstructive coronary artery disease (35 percent), compared with men (54 percent). Nearly 90 percent of women and men, either with or without obstructive disease, reported chest pain. While women reported more symptoms than men (9.0 percent vs. 7.2 percent; p<0.001), machine learning algorithms identified nine symptom clusters in which there were no significant differences between women and men.

While researchers said their findings do show important differences in how women describe their symptoms and physicians interpret them, angina symptoms are actually similar across both sexes with or without obstructive disease. Using "typical angina" to characterize symptoms in men and "atypical angina" for symptoms in women should be reevaluated.

Keywords: ESC 19, ESC Congress, Coronary Artery Disease, Angina Pectoris, Syndrome, Coronary Angiography, Chest Pain, Models, Statistical, Algorithms

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