In low to intermediate risk women with acute coronary syndromes, 75% had no significant coronary lesions by CCTA, and only 26% needed invasive angiography with 11.5% revascularized.
Does CCTA reduce the need for invasive coronary angiography in low-to-intermediate risk female patients presenting with NSTE-ACS?
In low-to-intermediate risk women with NSTE-ACS, CCTA demonstrates that 75% lack significant coronary lesions, highlighting its potential to safely reduce unnecessary invasive coronary angiography.
Absolute Event Rate: 0% vs 0%
Abstract Background In female patients presenting with an acute coronary syndrome (ACS) without high-risk features, there tends to be a unique /different pathophysiology compared to men, which can lead to misdiagnosis and delayed or inadequate treatment. Women with an ACS are less likely to have obstructive coronary artery disease (CAD), but appear to have a higher prevalence of other diagnosis such as: Spontaneous Coronary Artery Dissection, Stress Cardiomyopathy, Coronary Microvascular Dysfunction. Early recognition and gender-specific care can improve outcomes. This could be achieved, in low to intermediate risk ACS, with the use of coronary computed tomographic angiography (CCTA), a technique that has excellent sensitivity and negative predictive value. The purpose of this study is to describe the role of CCTA in non-ST elevation acute coronary syndromes in low and intermediate risk female patients. Methods 320 female patients were evaluated with a protocol that includes the use of CCTA in ACS. Women over 18 years of age with a diagnosis of ACS without ST elevation who did not meet high-risk criteria (hemodynamic instability, dynamic changes in the ST segment or T wave, ventricular arrhythmia, GRACE score 140, refractory angina, heart failure or cardiorespiratory arrest) and consulted the emergency department were included. Data collection was carried out between May 2022 and February 2025. Results 320 female patients were included, with a mean age of 58 years. Among the admission diagnoses, 23% were NSTEMI and 77% were unstable angina according to the 4th universal definition of acute myocardial infarction. The median high-sensitivity cardiac troponin T value was 5 nanograms per litre (interquartile range, 3.25 to 13) for the first troponin sample, and 9 nanograms per litre (interquartile range, 5 to 26) for the second troponin sample. It was observed that 36% did not have any coronary lesions or plaques. 39% had non-obstructive coronary artery disease (plaques 50%). The rest had significant lesions in at least one vessel (18%) or were nondiagnostic (7%). 26% of the patients included underwent invasive coronary angiography and 11.5% required revascularisation. Using Pearson's chi-square test we found a statiscally significant association between male gender and need for PCI((χ²) = 45.416, df = 1, p-value = 0.00). Conclusion This study shows that the prevalence of an ACS in women with coronary arteries without significant lesions by CCTA was 75%, which suggests CCTA could have a predominant role in the diagnostic algorithm of acute coronary syndromes without high-risk criteria, implying a decrease in the need of invasive studies in these patients. Only 26% required invasive coronary angiography, while revascularisation was performed in just 11.5% of all the patients. A more tailored approach in women with an ACS could improve diagnostic yield while doing so in a non-invasive manner, reducing the risks of complications or vascular injury.Table 1 CCTA findings and Pearson's Chi-square
Chapman et al. (Sat,) reported a other. In low to intermediate risk women with acute coronary syndromes, 75% had no significant coronary lesions by CCTA, and only 26% needed invasive angiography with 11.5% revascularized.