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Published on: August 9, 2024
Lack of sex disparity in cardiovascular testing after coronary computerized tomographic angiography
Catherine T Ginty1, Anna Marie Chang, Asako C Matsuura
1Department of Emergency Medicine, Cooper University Hospital, Camden, NJ, USA.
Insights
This study found no sex disparity in follow-up cardiac testing after coronary computed tomographic angiography (CTA) for potential acute coronary syndromes (ACS). Stenosis severity, not sex, predicted further testing, indicating equitable care post-CTA.
Area of Science:
- Cardiology
- Medical Imaging
- Health Services Research
Background:
- Sex disparities in healthcare are a concern, particularly in emergency department (ED) evaluations for potential acute coronary syndromes (ACS).
- Coronary computerized tomographic angiography (CTA) is increasingly used in the ED to assess coronary anatomy in patients with suspected ACS.
- Understanding potential sex-based differences in subsequent diagnostic workup after CTA is crucial for ensuring equitable patient care.
Purpose of the Study:
- To investigate whether a sex disparity exists in the utilization of follow-up cardiac testing after coronary CTA in emergency department patients presenting with potential ACS.
- To determine if sex influences the likelihood of receiving further diagnostic procedures irrespective of coronary anatomy findings.
Main Methods:
- A prospective cohort study was conducted involving 1,144 ED patients who underwent coronary CTA for potential ACS.
- Patient demographics, medical history, cardiac risk factors, and follow-up testing within 30 days were prospectively recorded.
- Outcomes were analyzed by stratifying patients based on sex and coronary CTA results (degree of maximal stenosis), focusing on the relative risk of receiving stress tests or catheterization.
Main Results:
- Men were initially found to be more likely to receive further testing (RR = 1.51).
- However, when stratified by the percentage of coronary stenosis, this difference disappeared (RR = 1.14), indicating no sex disparity in further testing.
- Multivariable analysis revealed that the degree of stenosis was a significant predictor of further testing (aRR = 1.51), while male sex, age, race, and TIMI risk score were not.
Conclusions:
- Male patients with potential ACS undergoing coronary CTA in the ED are not more likely than female patients to receive further cardiac testing within 30 days.
- The degree of coronary artery stenosis identified by CTA is the primary driver for subsequent diagnostic procedures, not patient sex.
- These findings suggest that coronary CTA may help mitigate sex-based disparities in the diagnostic workup of potential ACS in the emergency setting.
Objectives:
The authors assessed whether there was a sex disparity in testing of patients after coronary computerized tomographic angiography (CTA) was performed for emergency department (ED) patients with potential acute coronary syndromes (ACS). In theory, once coronary anatomy has been determined, any disparity in subsequent workup should not be the result of differences in presentation.
Methods:
This was a prospective cohort study of ED patients who presented with potential ACS and received coronary CTAs at a university hospital. Demographics, history, cardiac risk factors, follow-up testing, and procedures were recorded. Follow-up at 30 days was obtained by structured record review and telephone contact. Patients were stratified by sex and coronary CTA results (max stenosis: none, 1% to 24%, 25% to 49%, 50% to 69%, and ≥70%). Main outcome was the relative risk (RR) of a male receiving a stress test or catheterization within 30 days, stratified by categories of percent maximal stenosis.
Results:
A total of 1,144 patients received coronary CTAs (mean ± SD age = 47.8 ± 8.7 years), 55% were female, and 64% were black or African American. Overall, 161 patients received follow-up testing within 30 days, 113 during their index visit. Men were more likely to receive further testing (RR = 1.51; 95% confidence interval [CI] = 1.14 to 1.99) compared to women. However, when stratified by percentage of stenosis, men were not more likely to receive further testing within 30 days after coronary CTA compared to women (RR = 1.14; 95% CI = 0.68 to 1.91). In multivariable modeling for risk of further testing, stenosis remained significant (adjusted relative risk [aRR] = 1.51; 95% CI = 1.19 to 1.91), while male sex, age, race, and Thrombolysis in Myocardial Infarction (TIMI) risk score were not.
Conclusions:
Male patients with potential ACS who receive a coronary CTA as a part of their ED evaluation were no more likely than female patients to receive further testing within 30 days.
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