Sex Differences in Functional and CT Angiography Testing in Patients With Suspected Coronary Artery Disease.

Journal Article (Journal Article;Multicenter Study;Pragmatic Clinical Trial)

BACKGROUND: Although risk stratification is an important goal of cardiac noninvasive tests (NITs), few contemporary data exist on the prognostic value of different NITs according to patient sex. OBJECTIVES: The goal of this study was to compare the results and prognostic information derived from anatomic versus stress testing in stable men and women with suspected coronary artery disease. METHODS: In 8,966 patients tested at randomization (4,500 to computed tomography angiography [CTA], 52% female; 4,466 to stress testing, 53% female), we assessed the relationship between sex and NIT results and between sex and a composite of death, myocardial infarction, or unstable angina hospitalization. RESULTS: In women, a positive CTA (≥70% stenosis) was less likely than a positive stress test result (8% vs. 12%; adjusted odds ratio: 0.67). Compared with negative test results, a positive CTA was more strongly associated with subsequent clinical events than a positive stress test result (CTA-adjusted hazard ratio of 5.86 vs. stress-adjusted hazard ratio of 2.27; adjusted p = 0.028). Men were more likely to have a positive CTA than a positive stress test result (16% vs. 14%; adjusted odds ratio: 1.23). Compared with negative test results, a positive CTA was less strongly associated with subsequent clinical events than a positive stress test result in men, although this difference was not statistically significant (adjusted p = 0.168). Negative CTA and stress test results were equally likely to predict an event in both sexes. A significant interaction between sex, NIT type, and test result (p = 0.01) suggests that sex and NIT type jointly influence the relationship between test result and clinical events. CONCLUSIONS: The prognostic value of an NIT result varies according to test type and patient sex. Women seem to derive more prognostic information from a CTA, whereas men tend to derive similar prognostic value from both test types.

Full Text

Duke Authors

Cited Authors

  • Pagidipati, NJ; Hemal, K; Coles, A; Mark, DB; Dolor, RJ; Pellikka, PA; Hoffmann, U; Litwin, SE; Udelson, J; Daubert, MA; Shah, SH; Martinez, B; Lee, KL; Douglas, PS

Published Date

  • June 7, 2016

Published In

Volume / Issue

  • 67 / 22

Start / End Page

  • 2607 - 2616

PubMed ID

  • 27058908

Pubmed Central ID

  • PMC4892993

Electronic International Standard Serial Number (EISSN)

  • 1558-3597

Digital Object Identifier (DOI)

  • 10.1016/j.jacc.2016.03.523


  • eng

Conference Location

  • United States