Sex comparison of diagnostic accuracy of 64-multidetector row coronary computed tomographic angiography: results from the multicenter ACCURACY trial.
BACKGROUND
The diagnosis of coronary artery disease (CAD) in women remains a challenge, given their lower prevalence of obstructive disease and the suboptimal performance of traditional noninvasive tests (exercise electrocardiography and stress myocardial perfusion imaging). Coronary computed tomographic angiography (CTA) is a validated method for detection and exclusion of obstructive coronary artery stenosis.


OBJECTIVE
We compared the diagnostic accuracy of coronary CTA between men and women without known CAD with the use of invasive coronary angiography (ICA) as the reference standard.


METHODS
We prospectively evaluated 230 subjects with chest pain at 16 sites who were clinically referred for ICA. ICAs were evaluated for coronary stenosis according to quantitative coronary angiography.


RESULTS
Subjects (136 men and 94 women; mean ± age, 57 ± 10 years) underwent both CTA and ICA. For a patient-based model for stenosis >50%, sensitivity, specificity, positive and negative predictive values in men versus women were 96%, 78%, 69%, 100% and 90%, 88%, 47%, 99%, respectively. Subgroup analyses were performed for age and lifestyle risk factors. For stenosis > 50% in patients < 55 years, specificity in men versus women was 88% versus 95%, whereas for patients > 55 years, specificity in men versus women was 68% versus 82% (P < 0.05).


CONCLUSIONS
Coronary CTA found comparable diagnostic accuracy for women in comparison with men for the detection of obstructive coronary stenosis at both thresholds of 50% and 70%.
Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, 1124 West Carson Street, Torrance, CA 90502, USA.
Janet C
JC
Tsang
James K
JK
Min
Fay Y
FY
Lin
Leslee J
LJ
Shaw
Matthew J
MJ
Budoff
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000209:etiology; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D014481:United States