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

Publication ,  Journal Article
Pagidipati, NJ; Hemal, K; Coles, A; Mark, DB; Dolor, RJ; Pellikka, PA; Hoffmann, U; Litwin, SE; Udelson, J; Daubert, MA; Shah, SH; Martinez, B ...
Published in: J Am Coll Cardiol
June 7, 2016

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.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

June 7, 2016

Volume

67

Issue

22

Start / End Page

2607 / 2616

Location

United States

Related Subject Headings

  • United States
  • Sex Factors
  • Prognosis
  • Myocardial Perfusion Imaging
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart
 

Citation

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Chicago
ICMJE
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Pagidipati, N. J., Hemal, K., Coles, A., Mark, D. B., Dolor, R. J., Pellikka, P. A., … Douglas, P. S. (2016). Sex Differences in Functional and CT Angiography Testing in Patients With Suspected Coronary Artery Disease. J Am Coll Cardiol, 67(22), 2607–2616. https://doi.org/10.1016/j.jacc.2016.03.523
Pagidipati, Neha J., Kshipra Hemal, Adrian Coles, Daniel B. Mark, Rowena J. Dolor, Patricia A. Pellikka, Udo Hoffmann, et al. “Sex Differences in Functional and CT Angiography Testing in Patients With Suspected Coronary Artery Disease.J Am Coll Cardiol 67, no. 22 (June 7, 2016): 2607–16. https://doi.org/10.1016/j.jacc.2016.03.523.
Pagidipati NJ, Hemal K, Coles A, Mark DB, Dolor RJ, Pellikka PA, et al. Sex Differences in Functional and CT Angiography Testing in Patients With Suspected Coronary Artery Disease. J Am Coll Cardiol. 2016 Jun 7;67(22):2607–16.
Pagidipati, Neha J., et al. “Sex Differences in Functional and CT Angiography Testing in Patients With Suspected Coronary Artery Disease.J Am Coll Cardiol, vol. 67, no. 22, June 2016, pp. 2607–16. Pubmed, doi:10.1016/j.jacc.2016.03.523.
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. Sex Differences in Functional and CT Angiography Testing in Patients With Suspected Coronary Artery Disease. J Am Coll Cardiol. 2016 Jun 7;67(22):2607–2616.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

June 7, 2016

Volume

67

Issue

22

Start / End Page

2607 / 2616

Location

United States

Related Subject Headings

  • United States
  • Sex Factors
  • Prognosis
  • Myocardial Perfusion Imaging
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart