Key result
Women undergoing CCTA show similar angiography risk but ~27% lower revascularization risk than men.
Why the study?
Does gender influence the rate of subsequent invasive coronary angiography and coronary revascularisation in patients undergoing CCTA for chest discomfort?
Cohort (n=3,541)
No
Does gender influence the rate of subsequent invasive coronary angiography and coronary revascularisation in patients undergoing CCTA for chest discomfort?
Hazard Ratio: 0.98 (95% CI 0.85–1.13)
Absolute Event Rate: 18.3% vs 28.5%
p-value: p=<0.001
Women undergoing CCTA for chest discomfort have lower CAC scores and a modestly reduced risk of subsequent coronary revascularisation compared to men, even after adjusting for CAC.
Lower revascularisation rates in women persist after CAC adjustment; leaves open whether this reflects appropriate care or undertreatment.
BACKGROUND: In 'real-world' patient populations undergoing coronary CT angiography (CCTA), it is unclear whether a correlation exists between gender, coronary artery calcium (CAC) score and subsequent referral for invasive coronary angiography and coronary revascularisation. We therefore investigated the relationship between gender, CAC and use of subsequent invasive coronary angiography and coronary revascularisation in a cohort of patients with chest discomfort and low to intermediate pretest probability of coronary artery disease who underwent a CCTA at our diagnostic centre. METHODS: This is a cohort study that included patients examined between 2010 and 2013. Data were obtained from the Western Denmark Heart Registry. The follow-up ended 11 March 2014. RESULTS: A total of 3541 people (1621 men and 1920 women) were examined by CCTA. The rate of invasive coronary angiography during follow-up was 28.5% in men versus 18.3% in women (p<0.001). The rate of coronary revascularisation during follow-up was 11.4% in men versus 5.1% in women (p<0.001). The CAC-adjusted HR in women versus men was 0.98 (95% CI 0.85 to 1.13) for invasive coronary angiography and 0.73 (95% CI 0.57 to 0.93) for coronary revascularisation. Further adjustment for age and other risk factors did not change these estimates. CONCLUSIONS: Women had a lower CAC score than men and a corresponding lower rate of invasive coronary angiography. The risk of coronary revascularisation was modestly reduced in women, irrespective of CAC. This may reflect a gender-specific difference in coping with chest discomfort, gender-specific referral bias for CCTA, and/or a gender-specific difference in the balance between coronary calcification and obstructive coronary heart disease.
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Nørgaard et al. (2015) conducted a cohort in Chest discomfort and low to intermediate pretest probability of coronary artery disease (n=3,541). Female gender vs. Male gender was evaluated on Invasive coronary angiography (HR 0.98, 95% CI 0.85 to 1.13, p=<0.001). Compared to men, women undergoing CCTA had a similar CAC-adjusted risk of invasive coronary angiography (HR 0.98; 95% CI 0.85-1.13) but a lower risk of coronary revascularisation (HR 0.73).
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