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Sex associations and computed tomography coronary angiography-guided management in patients with stable chest pain

Kenneth Mangion1, Philip D Adamson2,3, Michelle C Williams2

  • 1British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, University of Glasgow, Glasgow G12 8TA, UK.

European Heart Journal
|December 29, 2019
PubMed

Insights

Computed tomography coronary angiography (CTCA) offers similar prognostic benefits for women and men with suspected coronary heart disease (CHD). CTCA reclassified more women as not having CHD, reducing unnecessary downstream tests and treatments.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Clinical Trials

Background:

  • The diagnostic and prognostic value of computed tomography coronary angiography (CTCA) in managing suspected coronary heart disease (CHD) and angina, particularly in women versus men, remains uncertain.
  • Women with suspected CHD often present with atypical symptoms, potentially impacting diagnostic accuracy and management strategies.

Purpose of the Study:

  • To investigate the relative benefits of CTCA-guided management in women and men presenting with suspected angina due to CHD.
  • To compare the effectiveness of CTCA in reclassifying CHD status and its impact on downstream testing and treatment in both sexes.

Main Methods:

  • A post hoc analysis of an open-label, parallel-group, multicentre trial involving 4146 patients referred for suspected angina.
  • Random assignment (1:1) to standard care or standard care plus CTCA.
  • Follow-up for a median of 4.8 years to assess outcomes such as CHD death or non-fatal myocardial infarction.

Main Results:

  • Fewer women presented with typical chest pain symptoms compared to men (32.0% vs. 37.9%).
  • In the CTCA-guided group, women were more likely to have normal coronary arteries (49.6% vs. 26.2%) and less obstructive CHD (11.5% vs. 29.8%).
  • CTCA reclassified more women as not having CHD (19.2% vs. 13.1%) or having angina due to CHD (15.0% vs. 9.0%), leading to cancellation of downstream tests and treatments.
  • CTCA-guided management showed similar risk reductions for CHD death or non-fatal myocardial infarction in women (HR 0.50) and men (HR 0.63) after 4.8 years.

Conclusions:

  • CTCA identifies a higher proportion of women with normal coronary arteries compared to men, leading to more accurate CHD reclassification and reduced unnecessary interventions.
  • CTCA-guided management provides comparable prognostic benefits for cardiovascular outcomes in both women and men with suspected angina.
  • The findings support the utility of CTCA in optimizing the diagnostic pathway and management of suspected CHD across sexes.
Abstract

Keywords:
AnginaCT coronary angiographyCTCACoronary heart diseaseGender

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