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Sex Associations and CCTA-Guided Management in Chest Pain Patients
Study Questions:
What are the relative effects of coronary computed tomography angiography (CCTA) on management and outcomes in women and men with stable chest pain?
Methods:
This study represents a post hoc analysis of data from the multicenter SCOT-HEART (Scottish Computed Tomography of the Heart) trial, which evaluated patients with stable chest pain and randomized subjects to standard care or standard care with CCTA. This analysis examined gender-specific differences in patient management and outcomes (myocardial infarction or death from coronary heart disease).
Results:
A total of 4,146 patients were enrolled in the study, including 1,821 women (44%). Women were less likely to have typical chest pain than men (32.0% vs. 37.9%, p < 0.001). In the cohort randomized to CCTA, women had higher rates of normal coronary arteries (49.6% vs. 26.2%) and lower rates of obstructive coronary artery disease (CAD) (11.5% vs. 29.8%; p < 0.001 overall). Based on CCTA, more women than men were reclassified as not having CAD (19.2% vs. 13.1%, p < 0.001) or having chest pain due to CAD (15.0% vs. 9.0%, p = 0.001). There were no differences in invasive coronary angiography or coronary revascularization at 6 weeks. At a median follow-up of 4.8 years, CCTA was associated with reduced rates of adverse events in women (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.24-1.04) and men (HR, 0.63; 95% CI, 0.42-0.95) (p value 0.57 for interaction between sex and treatment allocation).
Conclusions:
The use of CCTA in chest pain patients alters the diagnosis more frequently in women than in men. There were reduced rates of adverse events in patients randomized to CCTA, with the improved outcomes similar between women and men.
Perspective:
The SCOT-HEART trial found that patients with stable chest pain randomized to CCTA (vs. standard care) had similar rates of invasive angiography and coronary revascularization at 5 years, increased use of preventative therapies (e.g., aspirin and statins) and antianginal therapies, and reduced rates of myocardial infarction and death from coronary heart disease. This post hoc analysis examined results by gender and observed that diagnosis changes occurred more frequently in women than in men, with women having higher rates of normal coronary arteries and lower rates of obstructive CAD. There were no differences in invasive angiography or coronary revascularization at 6 weeks. Patients with CCTA had improved outcomes, with comparable outcomes for both women and men. These findings support the clinical utility of CCTA in both women and men with stable chest pain.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Stable Ischemic Heart Disease, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Cardiac Surgery and SIHD, Nonstatins, Novel Agents, Statins, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging, Chronic Angina
Keywords: Angina, Stable, Aspirin, Cardiology Interventions, Chest Pain, Coronary Angiography, Coronary Artery Disease, Coronary Disease, Diagnostic Imaging, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Secondary Prevention, Tomography, X-Ray Computed, Women
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