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


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


CONCLUSIONS
• 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.
Department of Radiology, Erasmus MC, Room Ca207a, 's-Gravendijkwal 230, P.O. Box 2040, 3015 CE, Rotterdam, The Netherlands. a.dharampal@erasmusmc.nl
Anoeshka S
AS
Dharampal
Stella L
SL
Papadopoulou
Alexia
A
Rossi
Annick C
AC
Weustink
Nico R A
NR
Mollet
W Bob
WB
Meijboom
Lisan A
LA
Neefjes
Koen
K
Nieman
Eric
E
Boersma
Pim J
PJ
de Feijter
Gabriel P
GP
Krestin
D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011336:Probability; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D012737:Sex Factors