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Randomized Controlled Trial
. 2020 Apr 1;41(13):1337-1345.
doi: 10.1093/eurheartj/ehz903.

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

Kenneth Mangion  1 , Philip D Adamson  2   3 , Michelle C Williams  2 , Amanda Hunter  2 , Tania Pawade  2 , Anoop S V Shah  2 , Stephanie Lewis  2   4 , Nicholas A Boon  2 , Marcus Flather  5 , John Forbes  6 , Scott McLean  7 , Giles Roditi  1 , Edwin J R van Beek  2 , Adam D Timmis  8 , David E Newby  2 , David A McAllister  9 , Colin Berry  1
Affiliations
Randomized Controlled Trial

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

Kenneth Mangion et al. Eur Heart J. .

Abstract

Aims: The relative benefits of computed tomography coronary angiography (CTCA)-guided management in women and men with suspected angina due to coronary heart disease (CHD) are uncertain.

Methods and results: In this post hoc analysis of an open-label parallel-group multicentre trial, we recruited 4146 patients referred for assessment of suspected angina from 12 cardiology clinics across the UK. We randomly assigned (1:1) participants to standard care alone or standard care plus CTCA. Fewer women had typical chest pain symptoms (n = 582, 32.0%) when compared with men (n = 880, 37.9%; P < 0.001). Amongst the CTCA-guided group, more women had normal coronary arteries [386 (49.6%) vs. 263 (26.2%)] and less obstructive CHD [105 (11.5%) vs. 347 (29.8%)]. A CTCA-guided strategy resulted in more women than men being reclassified as not having CHD {19.2% vs. 13.1%; absolute risk difference, 5.7 [95% confidence interval (CI): 2.7-8.7, P < 0.001]} or having angina due to CHD [15.0% vs. 9.0%; absolute risk difference, 5.6 (2.3-8.9, P = 0.001)]. After a median of 4.8 years follow-up, CTCA-guided management was associated with similar reductions in the risk of CHD death or non-fatal myocardial infarction in women [hazard ratio (HR) 0.50, 95% CI 0.24-1.04], and men (HR 0.63, 95% CI 0.42-0.95; Pinteraction = 0.572).

Conclusion: Following the addition of CTCA, women were more likely to be found to have normal coronary arteries than men. This led to more women being reclassified as not having CHD, resulting in more downstream tests and treatments being cancelled. There were similar prognostic benefits of CTCA for women and men.

Keywords: Angina; CT coronary angiography; CTCA; Coronary heart disease; Gender.

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Figures

Figure 1
Figure 1
Trial design
Take home figure
Take home figure
Women were more likely than men to have (A) atypical chest pain and normal coronary arteries leading to (B) greater false-positive diagnoses of coronary heart disease and angina due to coronary heart disease. Overall, women had low rates of clinical events (coronary heart disease death or non-fatal myocardial infarction) at 5 years but derived a similar prognostic benefit from computed tomography coronary angiography as men. (C) Cumulative event curves for the principal long-term clinical endpoint in those assigned to standard care plus computed tomography coronary angiography (blue) and standard care alone (red) amongst women (solid lines) and men (dashed lines).
None
See this image and copyright information in PMC

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