Women, 'non-specific' chest pain, and normal or near-normal coronary angiograms are not synonymous with favourable outcome.

One of the more troubling findings from gender-based studies is the observation that only half of women who have chest pain suggesting ischaemia present stenotic coronary lesions (>50% lumen diameter narrowing), whereas the remainder show non-obstructive or apparently normal arteries at angiography. Women with chest pain and non-obstructive coronary artery disease (CAD) constitute a great source of consternation to practicing physicians. Among these patients, there are an unknown number who can be shown to be suffering from cardiac pain presumed to be ischaemic. Most of these women complain of chest pain and disability for years, and the morbidity is considerable. New findings demonstrate that some of these patients may be at an increased risk of myocardial infarction and cardiac death. Advanced coronary atheroma can be present despite a normal or near-normal coronary lumen, and may provide a link between seemingly normal coronary arteries and increased risk of future cardiac events.