Sex Differences in Computed Tomographic Angiography in Patients with Low and Intermediate Pretest Probability of Coronary Artery Disease
Cardiology and Angiology: An International Journal,
Background: Multi-slice computed tomography (MSCT) coronary angiography has become one of the hot spots in cardiovascular imaging technology. Many of the sex-based research have shown that women have different pathogenesis, clinical presentation and complication related to coronary artery disease (CAD) as compared to the males. The aim of this study investigated the relationship between gender and coronary artery calcium (CAC) in patients with chest discomfort with low and intermediate pretest probability of CAD who underwent Coronary computed tomography angiography (CCTA) and referrals by gender for subsequent invasive coronary angiography and revascularization.
Methods: This prospective cohort study included 200 patients suspected to have coronary artery disease, negative or equivocal stress tests, with no prior known coronary artery disease (CAD), intermediate pretest probability for CAD according to the scoring method of (15-65 points), and Low likelihood for CAD (< 15 points). Patients were divided into two groups according to gender and were followed up. All patients underwent Full history taking, full clinical examination, routine laboratory investigation, resting and exercise ECG, echocardiography, CT coronary angiography and invasive Coronary angiography.
Results: Patients with mild calcium score level were significantly higher in no CAD group than CAD group (p <0.001) and patients with high calcium score were significantly higher in CAD group than no CAD group (p <0.001). In univariate regression analysis age, typical chest pain, obesity, coronary Ca score, and hyperlipidemia are independent predictors for CAD in females. In multivariate regression analysis, age, typical chest pain, hypertension, and coronary Ca score are predictors for CAD in males. Coronary calcium score is a good predicator for CAD (AUC =0.901, 95% CI =0.851-0.938, p value <0.001). At cut off value > 101, it has 70.97% sensitivity, 90.79% specificity, 92.6% PPV, and 65.7% NPV. Moreover, it is a good predicator for CAD in females (AUC =0.894, 95% CI =0.823 – 0.944, p value <0.001). At cut off value > 101, it has 60.71% sensitivity, 91.67% specificity, 87.2% PPV, and 71.4% NPV.
Conclusions: In patients with chest discomfort with low and intermediate pretest probability of CAD who underwent CCTA and subsequent invasive coronary angiography and revascularization, female patients had lower age, hypertension, pretest probability score, calcium score, atypical angina, nonanginal chest pain and obstructive CAD but had higher BMI, typical angina than males’ group. In females, coronary calcium score is a good predicator for CAD. When its level exceeds 100, it has 60.71% sensitivity and 91.67% specificity. In addition, it was found that in females typical chest pain and coronary Ca score are predictors for CAD and in males, age, typical chest pain, hypertension, and coronary Ca score are predictors for CAD.
- Sex differences
- computed tomographic angiography
- pretest probability
- coronary artery disease
How to Cite
Bekkers E, Roos J. Coronary CTA: stenosis classification and quantification, including automated measures. J Cardiovasc Comput Tomogr. 2009;3:109-15.
Hoffmann U, Bamberg F. Is computed tomography coronary angiography the most accurate and effective noninvasive imaging tool to evaluate patients with acute chest pain in the emergency department? CT coronary angiography is the most accurate and effective noninvasive imaging tool for evaluating patients presenting with chest pain to the emergency department. Circ Cardiovasc Imaging. 2009;2:251-63.
Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336- 45.
Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990; 15:827-32.
Greco A, Capodanno D. Differences in coronary artery disease and outcomes of percutaneous coronary intervention with drug-eluting stents in women and men. Expert Rev Cardiovasc Ther. 2021;19:301-12.
Punthakee Z, Goldenberg R, Katz P. Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. Can J Diabetes. 2018;42 Suppl 1:10-5.
Mancia G, Fagard R, Narkiewicz K, et al. ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013; 31:1281-357.
Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016;37:2999-3058.
Wang TW, Asman K, Gentzke AS, et al. Tobacco Product Use Among Adults - United States, 2017. MMWR Morb Mortal Wkly Rep. 2018;67:1225-32.
Nuttall FQ. Body Mass Index: Obesity, BMI, and Health: A Critical Review. Nutr. 2015;50:117-28.
Genders TS, Steyerberg EW, Hunink MG, et al. Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts. BMJ. 2012;344:34-85.
Genders TS, Steyerberg EW, Hunink MG, et al. Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts. Bmj. 2012;344:e3485.
Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2017;39:119-77.
Mathur M, Al Maluli H, Patil P. Assessment of Cardiac Function by Echocardiography. Curr Treat Options Cardiovasc Med. 2015;17:36-44.
Chengode S. Left ventricular global systolic function assessment by echocardiography. Ann Card Anaesth. 2016;19:26-34.
van der Bijl N, Joemai RM, Geleijns J, et al. Assessment of Agatston coronary artery calcium score using contrast-enhanced CT coronary angiography. AJR Am J Roentgenol. 2010;195:1299-305.
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:563-95.
Dedic A, Genders TS, Ferket BS, et al. Stable angina pectoris: head-to-head comparison of prognostic value of cardiac CT and exercise testing. Radiology. 2011;261:428-36.
Zhang Y, Liu Y, Zhang H, et al. Impact of sex-specific differences in calculating the pretest probability of obstructive coronary artery disease in symptomatic patients: a coronary computed tomographic angiography study. Coron Artery Dis. 2019;30:124-30.
Hemal K, Pagidipati NJ, Coles A, et al. Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial. JACC Cardiovasc Imaging. 2016;9:337-46.
Wong MYZ, Yap J, Huang W, et al. Impact of Age and Sex on Subclinical Coronary Atherosclerosis in a Healthy Asian Population. JACC: Asia. 2021;1:93- 102.
Al Helali S, Abid Hanif M, Alshugair N, et al. Distributions and burden of coronary calcium in asymptomatic Saudi patients referred to computed tomography. Int J Cardiol Heart Vasc. 2021;37:100- 902.
McClelland RL, Chung H, Detrano R, et al. Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2006;113:30-7.
John J, Parikh PB, Thippeswamy G, et al. Sex-related disparities in obstructive coronary artery disease, percutaneous coronary intervention, and mortality in adults with cardiac arrest. Int J Cardiol. 2018;269:23-6.
Abbasi S, De Leon AP, Kassaian S, et al. Gender differences in the risk of coronary artery disease in iran. Iran J Public Health. 2012;41:36-47.
Choi HY, Shin SJ, Yoo J, et al. Coronary Calcium Score for the Prediction of Asymptomatic Coronary Artery Disease in Patients With Ischemic Stroke. Front Neurol. 2020;11:206-331.
Hanifehpour R, Motevalli M, Ghanaati H, et al. Diagnostic Accuracy of Coronary Calcium Score Less than 100 in Excluding Coronary Artery Disease. Iran J Radiol. 2016;13:16-70.
Salem HT, Sabek EAS. Value of Coronary Calcium Scoring in Symptomatic and Asymptomatic Coronary Artery Disease Patients. Curr Med Imaging. 2021;17:517-23.
Gheisari F, Emami M, Raeisi Shahraki H, et al. The Role of Gender in the Importance of Risk Factors for Coronary Artery Disease. Cardiol Res Pract. 2020;2020:27-80.
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