Gender influence on the diagnostic accuracy of 64-slice multislice computed tomography coronary angiography for detection of obstructive coronary artery disease

Abstract

Objective: To compare the diagnostic accuracy of 64-slice multislice computed tomography (MSCT) coronary angiography between female and male patients using conventional coronary angiography as the reference standard. Design: Diagnostic accuracy study. Setting: University hospital. Patients: 103 consecutive patients (51 men, 52 women, mean (SD) age 60 (10) years) with known and suspected coronary artery disease underwent 64-slice MSCT. Main outcome measures: Diagnostic accuracy of 64-slice MSCT to detect obstructive (>50% luminal narrowing) stenoses in men and women. Results: One male and two female patients were excluded from the analysis owing to non-diagnostic MSCT scans as a result of increased heart rate and breathing during the scan. Accordingly, on segmental level, 728/762 coronary segments were of sufficient quality in women (96% (95% CI 95% to 97%)) and 704/723 segments were interpretable in men (97% (95% CI 96% to 98%)). In the remaining 100 patients included in the further analyses, the sensitivity and specificity on a segmental level in women and men were 85% (95% CI 75% to 95%) vs 85% (95% CI 78% to 92%) and 99% (95% CI 98% to 100%) vs 99% (95% CI 98% to 100%), respectively. On a patient level, the sensitivity in women and men was 95% (95% CI 87% to 100%) vs 100%, specificity 93% (95% CI 83% to 100%) vs 89% (95% CI 74% to 100%), positive predictive value 91% (95% CI 79% to 100%) vs 94% (95% CI 86% to 100%), and negative predictive value 96% (95% CI 89% to 100%) vs 100%, respectively. Conclusion: The findings confirm the high diagnostic accuracy of 64-slice MSCT coronary angiography in both male and female patients.Coronary artery disease (CAD) is the leading cause of mortality in the Western world. Although in men mortality due to CAD appears to be declining, an increase has recently been observed in women. 1-3 Unfortunately, accurate diagnosis of CAD may be more challenging in women than in men. Limited exercise capacity is frequently encountered in women, resulting in inconclusive exercise electrocardiography results. In addition, higher false-positive rates may be seen. 2 As a result, a considerable proportion of women are unnecessarily referred for conventional invasive coronary angiography, and obstructive CAD is absent in nearly half of women undergoing invasive coronary angiography. 2 Multislice computed tomography (MSCT) coronary angiography allows direct non-invasive visualisation of coronary arteries and accurate detection of obstructive lesions as compared with invasive coronary angiography. Indeed, the reported mean sensitivity and specificity of 64-slice MSCT are 87% and 96%, respectively. 4 In particular, the negative predictive value was extremely high (approaching 100%), allowing reliable exclusion of CAD. Nevertheless, to date, women have been substantially under-represented in MSCT diagnostic accuracy studies, with only about 20% of included patients being female. 4 5 Accordingly, the purpose of this study was to compare the diagnostic accuracy of current 64-slice MSCT coronary angio...

Noninvasive Diagnostic Techniques for Coronary Disease in Women

“…42,43 In a series of 51 women and 52 men, the diagnostic sensitivity and specificity was similar by sex at 85% and 99%, respectively. 44 An important limitation for CTA is the ionizing radiation that should be used cautiously in younger women because of a heightened lifetime risk of cancer. Contemporary techniques and protocols that are optimized for decrease in radiation exposure should be used in symptomatic women at risk for CAD.…”

Computed Tomographic Perfusion Improves Diagnostic Power of Coronary Computed Tomographic Angiography in Women

“…While one study showed lower specificity, 28 another showed lower accuracy and higher rates of nondiagnostic exams. 29 Other studies have shown no difference in accuracy, including ACCURACY multicenter trial (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography).…”

Noninvasive cardiac imaging for the diagnosis of coronary artery disease in women

“…However, the evidence for the differences due to safety and efficacy of either imaging modality among both genders is not adequate (8,33). In a cohort of 103 subjects (51 women and 52 men), the diagnostic sensitivity and specificity of coronary CTA was similar by gender at 85% and 99%, respectively (34). In the ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) study, coronary CTA revealed a sensitivity and specificity for demonstration of >50% stenosis of 95% and 83% and for >70% stenosis of 94% and 83% (35).…”