title: Sex Differences in Functional and CT Angiography Testing in Patients With Suspected Coronary Artery Disease.
abstract: BACKGROUND
  Although risk stratification is an important goal of cardiac noninvasive tests (NITs), few contemporary data exist on the prognostic value of different NITs according to patient sex.
  
  
  OBJECTIVE
  The goal of this study was to compare the results and prognostic information derived from anatomic versus stress testing in stable men and women with suspected coronary artery disease.
  
  
  METHODS
  In 8,966 patients tested at randomization (4,500 to computed tomography angiography [CTA], 52% female; 4,466 to stress testing, 53% female), we assessed the relationship between sex and NIT results and between sex and a composite of death, myocardial infarction, or unstable angina hospitalization.
  
  
  RESULTS
  In women, a positive CTA (≥70% stenosis) was less likely than a positive stress test result (8% vs. 12%; adjusted odds ratio: 0.67). Compared with negative test results, a positive CTA was more strongly associated with subsequent clinical events than a positive stress test result (CTA-adjusted hazard ratio of 5.86 vs. stress-adjusted hazard ratio of 2.27; adjusted p = 0.028). Men were more likely to have a positive CTA than a positive stress test result (16% vs. 14%; adjusted odds ratio: 1.23). Compared with negative test results, a positive CTA was less strongly associated with subsequent clinical events than a positive stress test result in men, although this difference was not statistically significant (adjusted p = 0.168). Negative CTA and stress test results were equally likely to predict an event in both sexes. A significant interaction between sex, NIT type, and test result (p = 0.01) suggests that sex and NIT type jointly influence the relationship between test result and clinical events.
  
  
  CONCLUSIONS
  The prognostic value of an NIT result varies according to test type and patient sex. Women seem to derive more prognostic information from a CTA, whereas men tend to derive similar prognostic value from both test types.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. Electronic address: neha.pagidipati@dm.duke.edu.
authors.forename: Neha J
authors.initials: NJ
authors.lastname: Pagidipati
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Kshipra
authors.initials: K
authors.lastname: Hemal
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Adrian
authors.initials: A
authors.lastname: Coles
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Rowena J
authors.initials: RJ
authors.lastname: Dolor
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Sheldon E
authors.initials: SE
authors.lastname: Litwin
authors.affiliation: Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: James
authors.initials: J
authors.lastname: Udelson
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Daubert
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Svati H
authors.initials: SH
authors.lastname: Shah
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Beth
authors.initials: B
authors.lastname: Martinez
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002637:Chest Pain / Q000209:etiology; D000072226:Computed Tomography Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D025401:Echocardiography, Stress; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
keywords: coronary artery disease; imaging; noninvasive testing; prognosis; risk stratification