Key result
CTA and PET predict outcomes equally across sexes despite ~29% lower event rates in women.
Why the study?
Sex differences in disease profile and clinical outcomes following combined coronary CTA and PET perfusion imaging in suspected obstructive CAD remained to be evaluated.
Does combined coronary CTA and PET myocardial perfusion imaging predict outcomes equally in women and men with suspected CAD?
Cohort (n=1,948)
Does combined coronary CTA and PET myocardial perfusion imaging predict outcomes equally in women and men with suspected CAD?
Absolute Event Rate: 1.2% vs 1.7%
p-value: p=0.02
Combined coronary CTA and PET myocardial perfusion imaging provides equal prognostic value for predicting adverse events in both women and men with suspected CAD, despite women having a lower baseline prevalence of ischemia.
Supports equal prognostic utility of combined CTA/PET across sexes in suspected CAD; leaves open prospective validation before guiding management.
AIMS: Combined anatomical and functional imaging enables detection of non-obstructive and obstructive coronary artery disease (CAD) as well as myocardial ischaemia. We evaluated sex differences in disease profile and outcomes after combined computed tomography angiography (CTA) and positron emission tomography (PET) perfusion imaging in patients with suspected obstructive CAD. METHODS AND RESULTS: We retrospectively evaluated 1948 patients (59% women) referred for coronary CTA due to suspected CAD during the years 2008-2016. Patients with a suspected obstructive lesion on coronary CTA (n = 657) underwent 15O-water PET to assess stress myocardial blood flow (MBF). During a mean follow-up of 6.8 years, 182 adverse events (all-cause death, myocardial infarction, or unstable angina) occurred. Women had more often normal coronary arteries (42% vs. 22%, P < 0.001) and less often abnormal stress MBF (9% vs. 28%, P < 0.001) than men. The annual adverse event rate was lower in women vs. men (1.2% vs. 1.7%, P = 0.02). Both in women and men, coronary calcification, non-obstructive CAD, and abnormal stress MBF were independent predictors of events. Abnormal stress MBF was associated with 5.0- and 5.6-fold adverse event rates in women and men, respectively. There was no interaction between sex and coronary calcification, non-obstructive CAD, or abnormal stress MBF in terms of predicting adverse events. CONCLUSION: Among patients evaluated for chronic chest pain, women have a lower prevalence of ischaemic CAD and a lower rate of adverse events. Combined coronary CTA and PET myocardial perfusion imaging predict outcomes equally in women and men.
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Kujala et al. (2023) conducted a cohort in suspected obstructive CAD (n=1,948). Female sex vs. Male sex was evaluated on adverse events (all-cause death, myocardial infarction, or unstable angina) (p=0.02). Among patients with suspected CAD, women had a lower annual adverse event rate than men (1.2% vs. 1.7%, P=0.02), and combined CTA and PET perfusion imaging predicted outcomes equally in both sexes.
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