title: Single-centre cohort study of gender influence in coronary CT angiography in patients with a low to intermediate pretest probability of coronary heart disease.
abstract: In 'real-world' patient populations undergoing coronary CT angiography (CCTA), it is unclear whether a correlation exists between gender, coronary artery calcium (CAC) score and subsequent referral for invasive coronary angiography and coronary revascularisation. We therefore investigated the relationship between gender, CAC and use of subsequent invasive coronary angiography and coronary revascularisation in a cohort of patients with chest discomfort and low to intermediate pretest probability of coronary artery disease who underwent a CCTA at our diagnostic centre.
  
  
  
  This is a cohort study that included patients examined between 2010 and 2013. Data were obtained from the Western Denmark Heart Registry. The follow-up ended 11 March 2014.
  
  
  
  A total of 3541 people (1621 men and 1920 women) were examined by CCTA. The rate of invasive coronary angiography during follow-up was 28.5% in men versus 18.3% in women (p<0.001). The rate of coronary revascularisation during follow-up was 11.4% in men versus 5.1% in women (p<0.001). The CAC-adjusted HR in women versus men was 0.98 (95% CI 0.85 to 1.13) for invasive coronary angiography and 0.73 (95% CI 0.57 to 0.93) for coronary revascularisation. Further adjustment for age and other risk factors did not change these estimates.
  
  
  
  Women had a lower CAC score than men and a corresponding lower rate of invasive coronary angiography. The risk of coronary revascularisation was modestly reduced in women, irrespective of CAC. This may reflect a gender-specific difference in coping with chest discomfort, gender-specific referral bias for CCTA, and/or a gender-specific difference in the balance between coronary calcification and obstructive coronary heart disease.
authors.affiliation: Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital , Silkeborg , Denmark.
authors.forename: Kirsten Schou
authors.initials: KS
authors.lastname: Nørgaard
authors.affiliation: Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital , Silkeborg , Denmark.
authors.forename: Christin
authors.initials: C
authors.lastname: Isaksen
authors.affiliation: Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital , Silkeborg , Denmark.
authors.forename: Jørgen Selmer
authors.initials: JS
authors.lastname: Buhl
authors.affiliation: Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital , Silkeborg , Denmark.
authors.forename: Jane
authors.initials: J
authors.lastname: Kirk Johansen
authors.affiliation: Institute for Clinical Medicine, Aarhus University Hospital , Silkeborg , Denmark.
authors.forename: Agnete Hedemann
authors.initials: AH
authors.lastname: Nielsen
authors.affiliation: Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital , Silkeborg , Denmark.
authors.forename: Aage
authors.initials: A
authors.lastname: Nørgaard
authors.affiliation: Institute for Clinical Medicine, Aarhus University Hospital , Silkeborg , Denmark.
authors.forename: Grazina
authors.initials: G
authors.lastname: Urbonaviciene
authors.affiliation: Department of Cardiothoracic and Vascular Surgery , Centre for Individualised Medicine in Arterial Disease, Odense University Hospital , Odense , Denmark.
authors.forename: Jes S
authors.initials: JS
authors.lastname: Lindholt
authors.affiliation: Institute for Clinical Medicine, Aarhus University Hospital , Silkeborg , Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Frost
keywords: CORONARY ARTERY DISEASE; IMAGING AND DIAGNOSTICS