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Computed tomography coronary angiography accuracy in women and men at low to intermediate risk of coronary artery disease.

Dharampal AS, Papadopoulou SL, Rossi A, Weustink AC, Mollet NR, Meijboom WB, Neefjes LA, Nieman K, Boersma E, de Feijter PJ, Krestin GP - Eur Radiol (2012)

Bottom Line: P < 0.05 was considered significant.Sensitivity, specificity, PPV and NPV were not significantly different in and between women and men at low and intermediate risk.For intermediate risk they were 99 % vs. 99 %, 72 % vs. 83 %, 88 % vs. 93 % and 98 % vs. 99 %, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Erasmus MC, Room Ca207a, 's-Gravendijkwal 230, P.O. Box 2040, 3015 CE, Rotterdam, The Netherlands. a.dharampal@erasmusmc.nl

ABSTRACT

Objectives: To investigate the diagnostic accuracy of CT coronary angiography (CTCA) in women at low to intermediate pre-test probability of coronary artery disease (CAD) compared with men.

Methods: In this retrospective study we included symptomatic patients with low to intermediate risk who underwent both invasive coronary angiography and CTCA. Exclusion criteria were previous revascularisation or myocardial infarction. The pre-test probability of CAD was estimated using the Duke risk score. Thresholds of less than 30 % and 30-90 % were used for determining low and intermediate risk, respectively. The diagnostic accuracy of CTCA in detecting obstructive CAD (≥50 % lumen diameter narrowing) was calculated on patient level. P < 0.05 was considered significant.

Results: A total of 570 patients (46 % women [262/570]) were included and stratified as low (women 73 % [80/109]) and intermediate risk (women 39 % [182/461]). Sensitivity, specificity, PPV and NPV were not significantly different in and between women and men at low and intermediate risk. For women vs. men at low risk they were 97 % vs. 100 %, 79 % vs. 90 %, 80 % vs. 80 % and 97 % vs. 100 %, respectively. For intermediate risk they were 99 % vs. 99 %, 72 % vs. 83 %, 88 % vs. 93 % and 98 % vs. 99 %, respectively.

Conclusion: CTCA has similar diagnostic accuracy in women and men at low and intermediate risk.

Key points: • Coronary artery disease (CAD) is increasingly investigated by computed tomography angiography (CTCA). • CAD detection or exclusion by CTCA is not different between sexes. • CTCA diagnostic accuracy was similar between low and intermediate risk sex-specific-groups. • CTCA rarely misses obstructive CAD in low-intermediate risk women and men. • CAD yield by invasive coronary angiography after positive CTCA is similar between sex-risk-specific groups.

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Related in: MedlinePlus

CAD detection by CTCA and its influence on the yield of CAD by ICA
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Fig1: CAD detection by CTCA and its influence on the yield of CAD by ICA

Mentions: A negative CTCA would prevent 31 % (174/570) of the low to intermediate risk patients proceeding to ICA (30 % (79/262) women; 31 % (95/308) men, P = 0.86; Fig. 1). This prevention of ICA would be more pronounced in patients at low risk (low 49 % (53/109) vs. intermediate 26 % (121/461), P < 0.001) compared to patients at intermediate risk. Obstructive CAD would be missed in less than 1 % after a negative CTCA with no significant differences between women and men (1 % (2/262) women vs. 0 % (1/308) men, P = 0.48), or between the low and intermediate risk groups (1 % (1/109) low vs. 0 % (2/461) intermediate risk group, P = 0.52). A positive CTCA would result in 89 % (353/396) yield of obstructive CAD by ICA with no significant differences between women and men (86 % (157/183) women vs. 92 % (196/213) men, P = 0.0502) or between the low and intermediate risk groups (80 % (45/56) low vs. 91 % (308/340) intermediate risk group, P = 0.06).


Computed tomography coronary angiography accuracy in women and men at low to intermediate risk of coronary artery disease.

Dharampal AS, Papadopoulou SL, Rossi A, Weustink AC, Mollet NR, Meijboom WB, Neefjes LA, Nieman K, Boersma E, de Feijter PJ, Krestin GP - Eur Radiol (2012)

CAD detection by CTCA and its influence on the yield of CAD by ICA
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3472076&req=5

Fig1: CAD detection by CTCA and its influence on the yield of CAD by ICA
Mentions: A negative CTCA would prevent 31 % (174/570) of the low to intermediate risk patients proceeding to ICA (30 % (79/262) women; 31 % (95/308) men, P = 0.86; Fig. 1). This prevention of ICA would be more pronounced in patients at low risk (low 49 % (53/109) vs. intermediate 26 % (121/461), P < 0.001) compared to patients at intermediate risk. Obstructive CAD would be missed in less than 1 % after a negative CTCA with no significant differences between women and men (1 % (2/262) women vs. 0 % (1/308) men, P = 0.48), or between the low and intermediate risk groups (1 % (1/109) low vs. 0 % (2/461) intermediate risk group, P = 0.52). A positive CTCA would result in 89 % (353/396) yield of obstructive CAD by ICA with no significant differences between women and men (86 % (157/183) women vs. 92 % (196/213) men, P = 0.0502) or between the low and intermediate risk groups (80 % (45/56) low vs. 91 % (308/340) intermediate risk group, P = 0.06).

Bottom Line: P < 0.05 was considered significant.Sensitivity, specificity, PPV and NPV were not significantly different in and between women and men at low and intermediate risk.For intermediate risk they were 99 % vs. 99 %, 72 % vs. 83 %, 88 % vs. 93 % and 98 % vs. 99 %, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Erasmus MC, Room Ca207a, 's-Gravendijkwal 230, P.O. Box 2040, 3015 CE, Rotterdam, The Netherlands. a.dharampal@erasmusmc.nl

ABSTRACT

Objectives: To investigate the diagnostic accuracy of CT coronary angiography (CTCA) in women at low to intermediate pre-test probability of coronary artery disease (CAD) compared with men.

Methods: In this retrospective study we included symptomatic patients with low to intermediate risk who underwent both invasive coronary angiography and CTCA. Exclusion criteria were previous revascularisation or myocardial infarction. The pre-test probability of CAD was estimated using the Duke risk score. Thresholds of less than 30 % and 30-90 % were used for determining low and intermediate risk, respectively. The diagnostic accuracy of CTCA in detecting obstructive CAD (≥50 % lumen diameter narrowing) was calculated on patient level. P < 0.05 was considered significant.

Results: A total of 570 patients (46 % women [262/570]) were included and stratified as low (women 73 % [80/109]) and intermediate risk (women 39 % [182/461]). Sensitivity, specificity, PPV and NPV were not significantly different in and between women and men at low and intermediate risk. For women vs. men at low risk they were 97 % vs. 100 %, 79 % vs. 90 %, 80 % vs. 80 % and 97 % vs. 100 %, respectively. For intermediate risk they were 99 % vs. 99 %, 72 % vs. 83 %, 88 % vs. 93 % and 98 % vs. 99 %, respectively.

Conclusion: CTCA has similar diagnostic accuracy in women and men at low and intermediate risk.

Key points: • Coronary artery disease (CAD) is increasingly investigated by computed tomography angiography (CTCA). • CAD detection or exclusion by CTCA is not different between sexes. • CTCA diagnostic accuracy was similar between low and intermediate risk sex-specific-groups. • CTCA rarely misses obstructive CAD in low-intermediate risk women and men. • CAD yield by invasive coronary angiography after positive CTCA is similar between sex-risk-specific groups.

Show MeSH
Related in: MedlinePlus