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Age- and Gender-Specific Differences in the Prognostic Value of CT Coronary Angiography
Study Questions:
Does the prognostic value of computed tomography coronary angiography (CTA) vary by age and gender?
Methods:
This was a multicenter prospective study using a registry of patients who had undergone CTA for suspected coronary artery disease (CAD). Exclusion criteria included cardiac arrhythmias, renal insufficiency, known hypersensitivity to iodine contrast media, pregnancy, previous percutaneous coronary intervention, and myocardial infarction or uninterruptable scans. Patients were stratified into four groups by age and gender (males vs. females, and age <60 vs. 60 or greater). Follow-up data were collected by clinical visits or standardized telephone interviews with each patient, a direct relative, or with the referring doctor to discuss symptoms. The primary endpoint of interest was cardiac death and nonfatal myocardial infarction. Nonfatal myocardial infarction was defined based on criteria of typical angina, elevated cardiac enzyme levels, and typical changes on the electrocardiogram.
Results:
A total of 2,432 patients underwent CTA, of which 56% were male. The mean age of the cohort was 57 ± 12 years. Male patients were more likely to have a higher incidence of diabetes and smoking history, whereas female patients were more likely to be older, have a higher incidence of hypertension, and family history of CAD. A total of 2,097 (86%) patients were referred for CTA, owing to the presence of symptoms, whereas the remaining 335 (14%) patients were asymptomatic. For both male and female patients, the majority presented with an intermediate pretest likelihood, whereas female patients had a slightly higher frequency of low pretest likelihood. By CTA, 41% (n = 991) of patients had no CAD, 31% (n = 761) had nonsignificant CAD, and 28% (n = 680) had significant CAD. Over a median follow-up of 819 days, cardiovascular events occurred in 59 (2.4%) patients. The annualized event rate was 1.1% in the total population (men = 1.3% and women = 0.9%). In patients ages <60 years, the annualized event rate of male and female patients was 0.6% and 0.5%, respectively. Among patients ages ≥60 years, the annualized event rate was 1.9% in male and 1.1% in female patients. Observations on CTA predicted events in male patients, both ages <60 and ≥60 years, and in female patients ages ≥60 years (log-rank test in all groups, p < 0.01). However, CTA provided limited prognostic value in female patients ages <60 years (log-rank test, p = 0.45).
Conclusions:
The investigators concluded that CTA was of limited predictive value among females under the age of 60 years, as compared to male patients of any age or females 60 years or older.
Perspective:
Although longer-term follow-up will add to the information presented in this manuscript, the data presented here are clinically useful and suggest that young women, particularly those with few cardiovascular disease risk factors, have little prognostic information to gain from such testing.
Keywords: Coronary Artery Disease, Myocardial Infarction, Follow-Up Studies, Risk Factors, Electrocardiography, Smoking, Percutaneous Coronary Intervention, Prognosis, Incidence, Renal Insufficiency, Coronary Angiography, Coronary Stenosis, Cardiology, Cardiovascular Diseases, Risk Assessment
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