University of Limerick
Forbes_2020_Sex.pdf (1.1 MB)

Sex associations and computed tomography coronary angiography-guided management in patients with stable chest pain

Download (1.1 MB)
journal contribution
posted on 2020-04-20, 08:05 authored by Kenneth Mangion, Philip D. Adamson, Michelle C. Williams, Amanda Hunter, Tania A. Pawade, Anoop S.V. Shah, Stephanie Lewis, Nicholas A. Boon, Marcus Flather, John F. Forbes, Scott McLean, Giles Roditi, Edwin J.R. van Beek, Adam D. Timmis, David E. Newby, David A. McAllister, Colin Berry
The relative benefits of computed tomography coronary angiography (CTCA)-guided management in women and men with suspected angina due to coronary heart disease (CHD) are uncertain. Methods and results In this post hoc analysis of an open-label parallel-group multicentre trial, we recruited 4146 patients referred for assessment of suspected angina from 12 cardiology clinics across the UK. We randomly assigned (1:1) participants to standard care alone or standard care plus CTCA. Fewer women had typical chest pain symptoms (n = 582, 32.0%) when compared with men (n = 880, 37.9%; P < 0.001). Amongst the CTCA-guided group, more women had normal coronary arteries [386 (49.6%) vs. 263 (26.2%)] and less obstructive CHD [105 (11.5%) vs. 347 (29.8%)]. A CTCAguided strategy resulted in more women than men being reclassified as not having CHD {19.2% vs. 13.1%; absolute risk difference, 5.7 [95% confidence interval (CI): 2.7–8.7, P < 0.001]} or having angina due to CHD [15.0% vs. 9.0%; absolute risk difference, 5.6 (2.3–8.9, P = 0.001)]. After a median of 4.8 years follow-up, CTCA-guided management was associated with similar reductions in the risk of CHD death or non-fatal myocardial infarction in women [hazard ratio (HR) 0.50, 95% CI 0.24–1.04], and men (HR 0.63, 95% CI 0.42–0.95; Pinteraction = 0.572).Conclusion Following the addition of CTCA, women were more likely to be found to have normal coronary arteries than men. This led to more women being reclassified as not having CHD, resulting in more downstream tests and treatments being cancelled. There were similar prognostic benefits of CTCA for women and men.



European Heart Journal;41,pp. 1337–1345


Oxford University Press



Other Funding information

Scottish Government Health and Social Care Directorates



Usage metrics

    University of Limerick


    No categories selected


    Ref. manager