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

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.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Mangion K,Adamson PD,Williams MC,Hunter A,Pawade T,Shah ASV,Lewis S,Boon NA,Flather M,Forbes J,McLean S,Roditi G,van Beek EJR,Timmis AD,Newby DE,McAllister DA,Berry C

doi

10.1093/eurheartj/ehz903

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

1337-1345

issue

13

eissn

0195-668X

issn

1522-9645

pii

5688932

journal_volume

41

pub_type

杂志文章

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