Is there a difference in the diagnostic accuracy of computed tomography coronary angiography between women and men?

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Sex differences in cardiovascular disease presentation and prevalence are well-documented.
• Computed tomography coronary angiography (CTCA) is a non-invasive imaging modality for diagnosing coronary artery disease (CAD).
• Understanding the influence of sex on CTCA diagnostic performance is crucial for accurate patient management.

Purpose of the Study:

• To evaluate the impact of sex on the diagnostic accuracy of CTCA in identifying obstructive coronary artery disease (CAD).
• To compare the performance of CTCA between women and men across different analytical levels (patient, vessel, segment).

Main Methods:

• A cohort of 916 symptomatic patients without prior coronary intervention underwent both CTCA and invasive coronary angiography.
• Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio (DOR) were compared between sexes.
• Logistic multivariate regression models using generalized estimating equations were employed for adjusted analyses.

Main Results:

• Women were older, presented with less typical symptoms, and had lower CAD prevalence and severity than men.
• On a per-patient and per-vessel level, CTCA showed comparable diagnostic performance between sexes.
• On a per-segment level, CTCA exhibited lower sensitivity and DOR in women compared to men, although specificity, PPV, and NPV remained similar.

Conclusions:

• CTCA is a reliable tool for excluding obstructive CAD in both women and men.
• The diagnostic accuracy of CTCA for detecting individual obstructive lesions is reduced in women compared to men.
• Clinical interpretation of CTCA results in women should consider potential sex-specific performance differences, particularly at the segment level.