Decreased Diagnostic Accuracy of Multislice Coronary Computed Tomographic Angiography in Women with Atypical Angina Symptoms.
BACKGROUND
Multislice computed tomography (MSCT) coronary angiography (CAG) is a noninvasive technique with a reported high diagnostic accuracy for coronary artery disease (CAD). Women, more frequently than men, are known to develop atypical angina symptoms. The purpose of this study was to investigate whether the diagnostic accuracy of MSCT in women with atypical presentation differs from that in men.


METHODS
We enrolled 396 in-hospital patients (141 women and 255 men) with suspected or proven CAD who successively underwent both MSCT and invasive CAG. CAD was defined as any coronary stenosis of ≥50% on conventional invasive CAG, which was used as the reference standard. The patients were divided into typical and atypical groups based on their symptoms of angina pectoris. The diagnostic accuracy of MSCT, including its sensitivity, specificity, negative predictive value, and positive predictive value (PPV), was calculated to determine the usefulness of MSCT in assessing stenoses. The diagnostic performance of MSCT was also assessed by constructing receiver operating characteristic (ROC) curves.


RESULTS
The PPV (91% vs. 97%, χ2 = 5.705, P < 0.05) and diagnostic accuracy (87% vs. 93%, χ2 = 5.093,P< 0.05) of MSCT in detecting CAD were lower in women than in men. Atypical presentation was an independent influencing factor on the diagnostic accuracy of MSCT in women (odds ratio = 4.94, 95% confidence intervals: 1.16-20.92, Walds = 4.69, P < 0.05). Compared with those in the atypical group, women with typical angina pectoris had higher PPV (98% vs. 74%, χ2 = 17.283. P < 0.001), diagnostic accuracy (93% vs. 72%, χ2 = 9.571, P < 0.001), and area under the ROC curve (0.91 vs. 0.64, Z = 2.690, P < 0.01) in MSCT diagnosis.


CONCLUSIONS
Although MSCT is a reliable diagnostic modality for the exclusion of significant coronary artery stenoses in all patients, gender and atypical symptoms might have some influence on its diagnostic accuracy.
Department of Cardiology, Peking University People's Hospital; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing 100044, China.
Wen-Ying
WY
Jin
Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
Xiu-Juan
XJ
Zhao
Department of Cardiology, Peking University People's Hospital; Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital; Center for Cardiovascular Translational Research, Peking University People's Hospital, Beijing 100044, China.
Hong
H
Chen
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity