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

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.