Gender differences in the diagnostic efficacy of coronary CTA: Overutilization of coronary CTA in pre- and perimenopausal females?

Autor: Feuchtner GM; Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria. Electronic address: Gudrun.Feuchtner@i-med.ac.at., Lacaita PG; Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria., Barbieri F; Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany., Deeg J; Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria., Plank F; Tyrol Clinicum Hall, Department of Cardiology, Milser Strasse 10, Hall 6060, Austria., Beyer C; Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria., Senoner T; Department of Anaesthesiology and Intensive Care, Innsbruck Medical University, Anichstrasse 35, Innsbruck A 6020, Austria., Friedrich G; Department of Internal Medicine, Cardiology, Anichstrasse 35, Innsbruck 6020, Austria., Widmann G; Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2024 Aug 15; Vol. 409, pp. 132181. Date of Electronic Publication: 2024 May 14.
DOI: 10.1016/j.ijcard.2024.132181
Abstrakt: Objectives: Public campaigns such as the "Go-red-for-women"-initiative have raised heart-disease awareness and may trigger overutilization of coronary computed tomography angiography (CTA). Objective was to investigate the diagnostic efficacy of coronary CTA stratified by age and gender.
Methods: 1882 consecutive patients (58.9 ± 11 years;42.5% females) with low-to-intermediate pre-test-probability of coronary artery disease (CAD) referred to coronary CTA according to ESC-2019 guidelines, were included. Diagnostic efficacy was defined by the 1)negative CTA-rate 2)obstructive CAD (>50%stenosis) 3)High-risk-plaque and 4)CAC-score.
Results: The negative CTA rate was higher in females compared to males with 360/801 vs 292/1081 (45% vs 27%;p < 0.001). Females had a higher likelihood (OR 2.2:95%CI:1.81-2.67) of a negative CTA than males, despite they were older (p < 0.001). Obstructive disease prevalence was 25.6% and acceptable in both sexes (males vs females: 28.4% vs 21.8%;p = 0.0012). Males had more high-risk-plaque (23.6% vs 11.5%;p < 0.001). When stratifying age groups, negative CTA rate was highest in females <47 years (82.8%), but lower in males with 68.1% (p < 0.001), while obstructive disease prevalence was not different (males:6.5% vs females:4.6%:p = 0.874). Above 50 years, negative CTA rate (39.1% vs 17.6%,p < 0.001;OR 3.02:95%CI:2.381-3.823) was higher, and the obstructive disease rate was lower in females (24.8% vs 34.7%,p = 0.0003). SSPS Tm (V.25,IBM) was used for statistical analysis.
Conclusions: Above 50 years of age, diagnostic efficacy of coronary CTA is high in both males and females. In females <47 years, the negative CTA rate was highest with 82.8% and obstructive disease prevalence was low (4.6%), still justifying testing but recommending the use of specific tools (PROMISE minimal risk score) or other clinical tests for pre-selection.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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