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

Mangion, K. et al. (2020) Sex associations and computed tomography coronary angiography-guided management in patients with stable chest pain. European Heart Journal, 41(13), pp. 1337-1345. (doi: 10.1093/eurheartj/ehz903) (PMID:31883330) (PMCID:PMC7109601)

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Abstract

Aims: 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 CTCA-guided 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.

Item Type:Articles
Additional Information:The Chief Scientist Office of the Scottish Government Health and Social Care Directorates funded the trial with supplementary awards from the British Heart Foundation (RE/13/3/30183), Edinburgh and Lothian's Health Foundation Trust and the Heart Diseases Research Fund. KM was funded by a British Heart Foundation Clinical Training Fellowship (FS/15/54/31639). CB (RE/18/6134217) and DEN (CH09/002, RG/16/10/32375, RE/13/3/30183) are supported by the British Heart Foundation. DEN is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and McAllister, Professor David and Newby, Professor David and Roditi, Dr Giles and Mangion, Dr Kenneth
Authors: Mangion, K., Adamson, P. D., Williams, M. C., Hunter, A., Pawade, T., Shah, A. S.V., Lewis, S., Boon, N. A., Flather, M., Forbes, J., McLean, S., Roditi, G., van Beek, E. J.R., Timmis, A. D., Newby, D., McAllister, D., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:European Heart Journal
Publisher:Oxford University Press
ISSN:0195-668X
ISSN (Online):1522-9645
Published Online:28 December 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in European Heart Journal 41(13):1337-1345
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
172173Myocardial strain measurements in survivors of acute ST-elevation myocardial infarction: implementation and prognostic significance of novel magnetic resonance imaging methods.Colin BerryBritish Heart Foundation (BHF)FS/15/54/31639Institute of Cardiovascular & Medical Sciences