Sex Differences in Functional and CT Angiography Testing in Patients With Suspected Coronary Artery Disease
| Autor: | Pamela S. Douglas, Kerry L. Lee, Neha J. Pagidipati, Kshipra Hemal, Patricia A. Pellikka, Beth Martinez, Melissa A. Daubert, Rowena J. Dolor, Udo Hoffmann, Sheldon E. Litwin, Svati H. Shah, Adrian Coles, Daniel B. Mark, James E. Udelson |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Canada Chest Pain Computed Tomography Angiography Stress testing Myocardial Infarction Coronary Artery Disease 030204 cardiovascular system & hematology Chest pain Coronary artery disease 03 medical and health sciences Myocardial perfusion imaging 0302 clinical medicine Sex Factors Internal medicine medicine Humans 030212 general & internal medicine Myocardial infarction Angina Unstable Aged medicine.diagnostic_test Unstable angina business.industry Hazard ratio Myocardial Perfusion Imaging Heart Odds ratio Middle Aged medicine.disease Prognosis United States Hospitalization Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business psychological phenomena and processes Echocardiography Stress |
| Zdroj: | Journal of the American College of Cardiology. 67(22) |
| ISSN: | 1558-3597 |
| Popis: | Background Although risk stratification is an important goal of cardiac noninvasive tests (NITs), few contemporary data exist on the prognostic value of different NITs according to patient sex. Objectives The goal of this study was to compare the results and prognostic information derived from anatomic versus stress testing in stable men and women with suspected coronary artery disease. Methods In 8,966 patients tested at randomization (4,500 to computed tomography angiography [CTA], 52% female; 4,466 to stress testing, 53% female), we assessed the relationship between sex and NIT results and between sex and a composite of death, myocardial infarction, or unstable angina hospitalization. Results In women, a positive CTA (≥70% stenosis) was less likely than a positive stress test result (8% vs. 12%; adjusted odds ratio: 0.67). Compared with negative test results, a positive CTA was more strongly associated with subsequent clinical events than a positive stress test result (CTA-adjusted hazard ratio of 5.86 vs. stress-adjusted hazard ratio of 2.27; adjusted p = 0.028). Men were more likely to have a positive CTA than a positive stress test result (16% vs. 14%; adjusted odds ratio: 1.23). Compared with negative test results, a positive CTA was less strongly associated with subsequent clinical events than a positive stress test result in men, although this difference was not statistically significant (adjusted p = 0.168). Negative CTA and stress test results were equally likely to predict an event in both sexes. A significant interaction between sex, NIT type, and test result (p = 0.01) suggests that sex and NIT type jointly influence the relationship between test result and clinical events. Conclusions The prognostic value of an NIT result varies according to test type and patient sex. Women seem to derive more prognostic information from a CTA, whereas men tend to derive similar prognostic value from both test types. |
| Databáze: | OpenAIRE |
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