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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Age- and gender-specific differences in the prognostic value of CT coronary angiography
Kai Hang Yiu1, Fleur R de Graaf, Joanne D Schuijf
1Department of Cardiology, Leiden University Medical Center, The Netherlands.
Insights
Coronary artery disease (CAD) CT angiography has limited prognostic value in younger women. CTA findings are more predictive in men of all ages and older women, highlighting age and gender-specific differences in cardiovascular risk assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Public Health
Background:
- Coronary artery disease (CAD) remains a leading cause of mortality globally.
- Accurate risk stratification is crucial for effective patient management.
- CT coronary angiography (CTA) is a key diagnostic tool for suspected CAD.
Purpose of the Study:
- To investigate age- and gender-specific variations in CAD incidence.
- To assess the prognostic capability of CTA across different demographic groups.
- To identify potential disparities in CTA's predictive accuracy.
Main Methods:
- A multicentre prospective registry study included 2432 patients undergoing CTA.
- Patients were stratified by age (<60 vs. ≥60 years) and gender (male vs. female).
- The primary endpoint was a composite of cardiac death and non-fatal myocardial infarction.
Main Results:
- Significant CAD was found in 28% of patients; 2.4% experienced a cardiovascular event during follow-up.
- Annualized event rates were 1.3% for men and 0.9% for women.
- CTA findings predicted events in men (all ages) and women ≥60 years, but not in women <60 years.
Conclusions:
- CTA's prognostic value for coronary artery disease varies significantly by age and gender.
- CTA findings are less predictive in younger women (<60 years) compared to men and older women.
- These age- and gender-specific differences necessitate tailored approaches to cardiovascular risk assessment.
Objective:
To evaluate the potential age- and gender-specific differences in the incidence and prognostic value of coronary artery disease (CAD) in patients undergoing CT coronary angiography (CTA).
Design And Patients:
In this multicentre prospective registry study, 2432 patients (mean age 57 ± 12, 56% male) underwent CTA for suspected CAD. Patients were stratified into four groups according to age <60 or ≥60 years and, male or female gender.
Main Outcome Measures:
A composite end point of cardiac death and non-fatal myocardial infarction.
Results:
CTA results were normal in 991 (41%) patients, showed non-significant CAD in 761 (31%) patients and significant CAD in the remaining 680 (28%) patients. During follow-up (median 819 days, 25-75th centile 482-1142) a cardiovascular event occurred in 59 (2.4%) patients. The annualised event rate was 1.1% in the total population (men=1.3% and women=0.9%). In patients aged <60 years, the annualised event rate of male and female patients was 0.6% and 0.5%, respectively. Among patients aged ≥60 years the annualised event rate was 1.9% in male and 1.1% in female patients. Observations on CTA predicted events in male patients, both age <60 and ≥60 years and in female patients age ≥60 years (log-rank test in all groups, p<0.01). However, CTA provided limited prognostic value in female patients aged <60 years (log-rank test, p=0.45).
Conclusions:
After age and gender stratification, CTA findings were shown to be of limited predictive value in female patients aged <60 years as compared with male patients at any age and female patients aged ≥60 years.
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