In various risk models, the odds of in-hospital death after PCI have ranged from 25% to 80% higher for women than for men,1143 1147 although this trend might have improved in recent years after the higher incidence of diabetes mellitus and hypertension in women is taken into account.1148 The risk of procedural complications also ap- pears to be significantly higher in women.1149 Although fewer data on the experience of women after CABG are available, in the New York State registry, the odds of in-hospital death for women were 2-fold higher than for men.1149,1150 On the basis of these observations, the initial approach to therapy for women with SIHD should be to prescribe a full regimen of GDMT and to reserve consideration of revascularization for patients who do not obtain a satisfactory response or who experience unacceptable adverse effects. On the basis of the higher risk associated with PCI in women, it might be reasonable to adopt a more conservative approach in under- taking this procedure than in men, although the general principle of using revascularization in patients whose symp- toms are refractory to medical therapy and who are not satisfied with their current level of angina persists. 5.12.2. Older Adults In older adults, often defined as .75 years of age, coronary stenoses are likely to be more diffuse and more severe, with a higher prevalence of 3-vessel and left main disease. Several factors complicate the diagnosis and treatment of SIHD in this age group. Common coexisting conditions of the pulmo- nary, gastrointestinal, and musculoskeletal systems can cause chest pain, making diagnosis more difficult, even in patients with documented IHD. Physiological changes in older adults, including alterations in cardiac output through various mech- anisms, muscle loss and deconditioning, neuropathies, lung disease, and degenerative joint disease, make stress testing more difficult. 