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Sex Effect in the Decision to Perform Invasive Coronary Angiography in Patients With Chronic Coronary Syndrome After
Patricia Palau1,2,3, Julio Núñez1,2,3,4, Jose V Monmeneu5
1Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Insights
Sex does not impact invasive cardiac angiography (ICA) use after stress cardiac MRI overall. However, women with no ischemia were less likely to receive ICA, while women with ischemia showed increased ICA use compared to men.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Medical Imaging Techniques
- Cardiac MRI Applications
Background:
- Stress cardiac MRI is crucial for evaluating patients with known or suspected chronic coronary syndromes (CCS).
- The influence of sex on invasive cardiac angiography (ICA) utilization following vasodilator stress cardiac MRI remains unclear.
Purpose of the Study:
- To investigate the impact of sex on the decision to perform ICA after vasodilator stress cardiac MRI.
- To determine if sex influences ICA referral patterns in patients with suspected or known CCS.
Main Methods:
- Retrospective analysis of 6229 patients undergoing vasodilator stress cardiac MRI for CCS.
- Assessment of ischemic burden using stress first-pass perfusion imaging and a 17-segment model.
- Multivariate logistic regression to analyze the association between sex, ischemic burden, and ICA use.
Main Results:
- Overall, 17.8% of patients (1109/6229) underwent ICA, with a higher proportion of men (19.7%) than women (14.6%).
- Multivariate analysis revealed no significant difference in overall ICA use between sexes (OR=0.99, P=0.934).
- Significant sex differences emerged based on ischemia: women with no ischemia were less likely to have ICA (OR=0.49), while women with ischemia showed higher ICA use (OR=1.27).
Conclusions:
- In patients with CCS undergoing stress cardiac MRI, ICA may be overutilized in men without ischemia.
- Referral for ICA in patients with negative ischemia appears to be more common in men, potentially leading to increased revascularization rates.
- Sex-specific patterns in ICA referral exist, particularly in relation to the presence and severity of myocardial ischemia.
Background:
Stress cardiac MRI permits comprehensive evaluation of patients with known or suspected chronic coronary syndromes (CCS). The impact of sex on the use of invasive cardiac angiography (ICA) after vasodilator stress cardiac MRI is unclear.
Purpose:
To evaluate the impact of sex on ICA use after vasodilator stress cardiac MRI.
Study Type:
Retrospective.
Population:
A total of 6229 consecutive patients (age [mean ± standard deviation] 65.2 ± 11.5 years, 38.1% women).
Field Strength/Sequence:
A 5-T; a steady-state free-precession cine sequence; stress first-pass perfusion imaging; late enhancement imaging.
Assessment:
Patients underwent vasodilator stress cardiac MRI for known or suspected CCS. The ischemic burden (at stress first-pass perfusion imaging) was computed (17-segment model).
Statistical Tests:
Multivariate logistic regression was used to evaluate the potential differential association between ischemic burden and use of cardiac MRI-related ICA across sex.
Results:
A total of 1109 (17.8%) patients were referred to ICA, among which there were significantly more men (762, 19.7%) than women (347, 14.6%). Overall, after multivariate adjustment, female sex was not associated with lower use of ICA (odds ratio [OR] = 0.99; confidence interval [CI] 95%: 0.84-1.18, P = 0.934). However, significant sex differences were detected across ischemic burden. Whereas women with nonischemic vasodilator stress cardiac MRI (0 ischemic segments) were less commonly submitted to ICA (OR = 0.49; CI 95%: 0.35-0.69) in patients with ischemia (>1 ischemic segment), adjusted use of ICA was more frequent in women than men (OR = 1.27; CI 95%: 1.1-1.5).
Data Conclusions:
In patients with known or suspected CCS submitted to undergo vasodilator stress cardiac MRI, cardiac MRI-related ICA may be overused in men without ischemia. Furthermore, ICA referral in patients with negative ischemia resulted in greater odds of revascularization in men.
Evidence Level:
3 TECHNICAL EFFICACY: Stage 5.
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