Gender differences in the diagnostic efficacy of coronary CTA: Overutilization of coronary CTA in pre- and perimenopausal females?

Gudrun M Feuchtner; Pietro G Lacaita; Fabian Barbieri; Johannes Deeg; Fabian Plank; Christoph Beyer; Thomas Senoner; Guy Friedrich; Gerlig Widmann

doi:10.1016/j.ijcard.2024.132181

Gender differences in the diagnostic efficacy of coronary CTA: Overutilization of coronary CTA in pre- and perimenopausal females?

Int J Cardiol. 2024 May 14:409:132181. doi: 10.1016/j.ijcard.2024.132181. Online ahead of print.

Authors

Gudrun M Feuchtner¹, Pietro G Lacaita², Fabian Barbieri³, Johannes Deeg², Fabian Plank⁴, Christoph Beyer², Thomas Senoner⁵, Guy Friedrich⁶, Gerlig Widmann²

Affiliations

¹ Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria. Electronic address: Gudrun.Feuchtner@i-med.ac.at.
² Department of Radiology, Innsbruck Medical University, Anichstrasse 35, Innsbruck 6020, Austria.
³ Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Hindenburgdamm 30, Berlin 12203, Germany.
⁴ Tyrol Clinicum Hall, Department of Cardiology, Milser Strasse 10, Hall 6060, Austria.
⁵ Department of Anaesthesiology and Intensive Care, Innsbruck Medical University, Anichstrasse 35, Innsbruck A 6020, Austria.
⁶ Department of Internal Medicine, Cardiology, Anichstrasse 35, Innsbruck 6020, Austria.

PMID: 38754587
DOI: 10.1016/j.ijcard.2024.132181

Abstract

Objectives: Public campaigns such as the "Go-red-for-women"-initiative have raised heart-disease awareness and may trigger overutilization of coronary computed tomography angiography (CTA). Objective was to investigate the diagnostic efficacy of coronary CTA stratified by age and gender.

Methods: 1882 consecutive patients (58.9 ± 11 years;42.5% females) with low-to-intermediate pre-test-probability of coronary artery disease (CAD) referred to coronary CTA according to ESC-2019 guidelines, were included. Diagnostic efficacy was defined by the 1)negative CTA-rate 2)obstructive CAD (>50%stenosis) 3)High-risk-plaque and 4)CAC-score.

Results: The negative CTA rate was higher in females compared to males with 360/801 vs 292/1081 (45% vs 27%;p < 0.001). Females had a higher likelihood (OR 2.2:95%CI:1.81-2.67) of a negative CTA than males, despite they were older (p < 0.001). Obstructive disease prevalence was 25.6% and acceptable in both sexes (males vs females: 28.4% vs 21.8%;p = 0.0012). Males had more high-risk-plaque (23.6% vs 11.5%;p < 0.001). When stratifying age groups, negative CTA rate was highest in females <47 years (82.8%), but lower in males with 68.1% (p < 0.001), while obstructive disease prevalence was not different (males:6.5% vs females:4.6%:p = 0.874). Above 50 years, negative CTA rate (39.1% vs 17.6%,p < 0.001;OR 3.02:95%CI:2.381-3.823) was higher, and the obstructive disease rate was lower in females (24.8% vs 34.7%,p = 0.0003). SSPS^Tm(V.25,IBM) was used for statistical analysis.

Conclusions: Above 50 years of age, diagnostic efficacy of coronary CTA is high in both males and females. In females <47 years, the negative CTA rate was highest with 82.8% and obstructive disease prevalence was low (4.6%), still justifying testing but recommending the use of specific tools (PROMISE minimal risk score) or other clinical tests for pre-selection.

Keywords: Computed tomography angiography (CTA); Coronary artery disease; Diagnostic efficacy; Females.