Key result
Women with stable chest pain are ~43% less likely than men to undergo ICA after CTCA.
Why the study?
Sex-related differences in referral and management of stable chest pain according to NICE CG95 (2016) guidance in UK practice were unclear.
Are there sex-based inequalities in the downstream management (functional imaging, invasive angiography, and revascularisation) of patients undergoing CTCA for stable chest pain?
Observational (n=4,627)
Yes
Are there sex-based inequalities in the downstream management (functional imaging, invasive angiography, and revascularisation) of patients undergoing CTCA for stable chest pain?
Absolute Event Rate: 8% vs 14%
p-value: p=<0.001
Women undergoing CTCA for stable chest pain are significantly less likely than men to receive subsequent invasive angiography and revascularisation, even after adjusting for disease severity.
Sex disparities in ICA and revascularisation persist post-CTCA; leaves open whether NICE CG95 implementation mitigates bias in stable chest pain pathways.
OBJECTIVE: We surveyed UK practice of National Institute for Health and Care Excellence (NICE) "Recent onset chest pain" guidance (CG95, 2016), stratified by sex. We looked for sex-related differences in referral to computed tomographic coronary angiography (CTCA) and subsequent functional imaging (FI), invasive coronary angiography (ICA) and revascularisation. METHODS: This was a prospective analysis of CTCA practice in 8 UK centres between 2018 and 2020. Coronary artery disease (CAD) was recorded with the CAD-reporting and data system. Local electronic records/archiving/communication systems were used to collect data regarding subsequent FI, ICA and revascularisation. RESULTS: 2301 women, 2326 men underwent CTCA; women were older (58±11 vs 55±12 years, p<0.001) but more likely to have normal coronary arteries (46% (1047) vs 29% (685); p<0.001) and less likely to have severe stenosis (7% (169) vs 13% (307); p<0.001). FI was used less for 4% (93) women, 5% (108) men; ICA was also used less for women (8% (182) vs 14% (321)), as was revascularisation (4% (83) vs 8% (177), p<0.001 for all), including those with ≥moderate CTCA stenosis undergoing ICA (53% (79) vs 61% (166); p<0.001). CONCLUSIONS: Women referred for a NICE CG95 (2016) CTCA are more likely to have normal coronary arteries and men more likely to have CAD. More men than women will then undergo ICA and revascularisation even after adjustments for CTCA disease severity. Raised awareness of these inequalities may improve contemporary chest pain care.
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Morgan‐Hughes et al. (2021) conducted an observational in Stable chest pain (n=4,627). Female sex vs. Male sex was evaluated on Invasive coronary angiography (ICA) (p=<0.001). Women referred for CTCA for stable chest pain were less likely than men to undergo subsequent invasive coronary angiography (8% vs 14%, p<0.001) and revascularization (4% vs 8%, p<0.001).
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