Age-and Gender-Specific Differences in the Prognostic Value of CT Coronary Angiography

OBJECTIVES: To evaluate the potential age- and gender-specific differences in the incidence and prognostic value of coronary artery disease (CAD) in patients undergoing CT coronary angiography (CTA).

METHODS: In this multicentre prospective registry study, 2432 patients (mean age 57±12, 56% male) underwent CTA for suspected CAD. Patients were stratified into four groups according to age <60 or ≥60 years and, male or female gender.Main outcome measuresA composite end point of cardiac death and non-fatal myocardial infarction.

RESULTS: CTA results were normal in 991 (41%) patients, showed non-significant CAD in 761 (31%) patients and significant CAD in the remaining 680 (28%) patients. During follow-up (median 819 days, 25-75th centile 482-1142) a cardiovascular event occurred in 59 (2.4%) patients. The annualised event rate was 1.1% in the total population (men=1.3% and women=0.9%). In patients aged <60 years, the annualised event rate of male and female patients was 0.6% and 0.5%, respectively. Among patients aged ≥60 years the annualised event rate was 1.9% in male and 1.1% in female patients. Observations on CTA predicted events in male patients, both age <60 and ≥60 years and in female patients age ≥60 years (log-rank test in all groups, p<0.01). However, CTA provided limited prognostic value in female patients aged <60 years (log-rank test, p=0.45).

CONCLUSIONS: After age and gender stratification, CTA findings were shown to be of limited predictive value in female patients aged <60 years as compared with male patients at any age and female patients aged ≥60 years.

PMID: 21917657

Posted in Computed Tomography and tagged , , , , , .

4 Comments

  1. Females at a young age who have a low event rate, and may be more susceptible to the effect of ionizing radiation, may not be a optimal candidate for CCTA. In this study the prognostic value of CCTA in this group was low.

  2. See also :

    Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography.
    Einstein AJ, Henzlova MJ, Rajagopalan S.
    JAMA. 2007 Jul 18;298(3):317-23.
    PMID: 17635892

  3. The authors mention that CCTA did not have prognostic value in females<60 years of age. This is not an issue of sensitivity only, but of disease prevalence. CAG is appropriate in patients with high likelihood of disease (and if you believe in the Diamond-Forrester Table, females are not frequently there). Anyway, most imaging modalities including CCTA have lower predictive value in females and in young adults in general.

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