Calcium imaging and selective computed tomography angiography in comparison to functional testing for suspected coronary artery disease: the multicentre, randomized CRESCENT trial

Lubbers, Marisa; Dedic, Admir; Coenen, Adriaan; Galema, Tjebbe W.; Akkerhuis, Jurgen; Bruning, T. A.; Krenning, Boudewijn J.; Musters, Paul; Ouhlous, Mohamed; Liem, Ahno; Niezen, André; Hunink, M. G. Myriam; Feijter, Pim de; Nieman, Koen

doi:10.1093/eurheartj/ehv700

Cited by 163 publications

(105 citation statements)

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“…In women, as well as the cohort as a whole, 12 cardiac CT more often resulted in resolved anginal symptoms after 1 year in comparison to functional testing. This can be explained by a higher diagnostic performance of CT, followed by more appropriate management of cardiac and noncardiac conditions.…”

Section: Sex Differences In the Performance Of Diagnostic Testingmentioning

confidence: 92%

“…11 Recently, 3 multicenter randomized trials showed that cardiac CT is at least as effective and safe as standard diagnostic testing for patients with suspected CAD. [12][13][14] Given the uncertain diagnostic accuracy of functional tests in women, direct visualization of CAD by cardiac CT may be particularly effective in women.…”

Section: Sex Differences In Performance Of Cardiac Ctmentioning

confidence: 99%

“…The study design, inclusion and exclusion criteria, and primary results have been reported previously. 12 Briefly, all adult patients with stable chest pain or angina equivalent symptoms potentially caused by obstructive CAD were considered for study participation. Exclusion criteria were a history of known CAD, invasive coronary angiography or stress test performed <1 year ago, or inability or unwillingness to provide informed consent.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…27,28 PROMISE and SCOT-HEART, as well as CRESCENT, have demonstrated that cardiac CT is equally or more effective and safe as standard diagnostic testing for patients with suspected CAD. [12][13][14] This subanalysis underlines the notion that cardiac CT is more efficient in women in terms of less downstream testing and a speedier diagnosis, compared with functional testing.…”

Section: Diagnostic Management Of Suspected Cad In Women and Menmentioning

confidence: 99%

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Sex Differences in the Performance of Cardiac Computed Tomography Compared With Functional Testing in Evaluating Stable Chest Pain

Lubbers

Coenen

Bruning

et al. 2017

Circ: Cardiovascular Imaging

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I n industrialized countries, coronary artery disease (CAD) is the leading cause of death among women and associated with a worse outcome compared with men.1,2 Because of a frequently different presentation of complaints, ischemic heart disease is thought to be under-recognized in women. 3,4 The prevalence of vasospasm and microvascular angina is higher in women, which may partly explain the differences in symptoms between women and men. 4 Conventional first-line noninvasive diagnostic tests are thought to be less accurate in women, further contributing to underdiagnosis and potentially undertreatment. 5,6 On the other hand, women have higher rates of indeterminate exercise ECG results but also more falsepositive results because of nonspecific ST-T segment changes. The lower sensitivity of nuclear imaging is thought to result from the smaller size of the female heart, although falsepositive diagnoses may be introduced by breast attenuation artifacts. 7,8 Paradoxically, there seems to be a relative overuseBackground-Cardiac computed tomography (CT) represents an alternative diagnostic strategy for women with suspected coronary artery disease, with potential benefits in terms of effectiveness and cost-efficiency. Methods and Results-The CRESCENT trial (Calcium Imaging and Selective CT Angiography in Comparison to FunctionalTesting for Suspected Coronary Artery Disease) prospectively randomized 350 patients with stable angina (55% women; aged 55±10 years), mostly with an intermediate coronary artery disease probability, between cardiac CT and functional testing. The tiered cardiac CT protocol included a calcium scan followed by CT angiography if the Agatston calcium score was between 1 and 400. Patients with test-specific contraindications were not excluded from study participation. Sex differences were studied as a prespecified subanalysis. Enrolled women presented more frequently with atypical chest pain and had a lower pretest probability of coronary artery disease compared with men. Independently of these differences, cardiac CT led in both sexes to a fast final diagnosis when compared with functional testing, although the effect was larger in women (P interaction=0.01). The reduced need for further testing after CT, compared with functional testing, was most evident in women (P interaction=0.009). However, no sex interaction was observed with respect to changes in angina and quality of life, cumulative diagnostic costs, and applied radiation dose (all P interactions≥0.097). Conclusions-Cardiac CT is more efficient in women than in men in terms of time to reach the final diagnosis and downstream testing. However, overall clinical outcome showed no significant difference between women and men after 1 year. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01393028. Cardiac computed tomography (CT) is a noninvasive imaging modality with an excellent diagnostic accuracy for the detection of CAD in both men and women.11 Recently, 3 multicenter randomized trials showed that cardi...

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Section: Sex Differences In the Performance Of Diagnostic Testingmentioning

confidence: 92%

Section: Sex Differences In Performance Of Cardiac Ctmentioning

confidence: 99%

Section: Study Design and Participantsmentioning

confidence: 99%

Section: Diagnostic Management Of Suspected Cad In Women and Menmentioning

confidence: 99%

See 2 more Smart Citations

Sex Differences in the Performance of Cardiac Computed Tomography Compared With Functional Testing in Evaluating Stable Chest Pain

Lubbers

Coenen

Bruning

et al. 2017

Circ: Cardiovascular Imaging

Self Cite

View full text Add to dashboard Cite

show abstract

“…Exercise Testing in Suspected Coronary Artery Disease (CRESCENT) trial had a similar design than PROMISE albeit with a considerably smaller study population (n = 350). 17 Moreover, patients in the anatomical arm followed a tiered CT protocol including a 'gate-keeper' CACS scan followed by coronary CTA only if CACS was between 1 and 400. After 1.2 years, event-free survival was 96.7% for patients randomized to CT and 89.8% for patients randomized to functional testing (P = 0.011).…”

mentioning

confidence: 99%