Sex Differences in the Effectiveness of Early Coronary Computed Tomographic Angiography Compared with Standard Emergency Department Evaluation for Acute Chest Pain: the Rule-out Myocardial Infarction with Computer-Assisted Tomography (ROMICAT)-II...

Overview

Journal Circulation

Specialty Cardiology & Vascular Diseases

Date 2013 May 21

PMID 23685743

Citations 18

Authors

Quynh A Truong

Douglas Hayden

Pamela K Woodard

Ruth Kirby

Eric T Chou

John T Nagurney

Stephen D Wiviott

Jerome L Fleg

David A Schoenfeld

James E Udelson

Udo Hoffmann

Affiliations

Soon will be listed here.

Abstract

Background: We evaluate sex-based differences in the effectiveness of early cardiac computed tomographic angiography (CCTA) and standard emergency department (ED) evaluation in patients with acute chest pain.

Methods And Results: In the Rule-Out Myocardial Infarction With Computer-Assisted Tomography (ROMICAT)-II multicenter, controlled trial, we randomized 1000 patients (47% women) 40 to 74 years of age with symptoms suggestive of acute coronary syndrome to an early CCTA or standard ED evaluation. In this prespecified analysis, women in the CCTA arm had a greater reduction in length of stay, lower hospital admission rates, and lesser increased cumulative radiation dose than men in a comparison of ED strategies (P for interaction ≤0.02). Although women had lower acute coronary syndrome rates than men (3% versus 12%; P<0.0001), sex differences in length of stay persisted after adjustment for baseline differences, including acute coronary syndrome rate (P for interaction <0.03). Length of stay was similar between sexes with normal CCTA findings (P=0.11). There was no missed acute coronary syndrome for either sex. No difference was observed in major adverse cardiac events between sexes and ED strategies (P for interaction =0.39). Women had more normal CCTA examinations than men (58% versus 37%; P<0.0001), less obstructive coronary disease by CCTA (5% versus 17%; P=0.0001), but similar normalcy rates for functional testing (P=0.65). Men in the CCTA arm had the highest rate of invasive coronary angiography (18%), whereas women had comparable low 5% rates regardless of ED strategy.

Conclusions: This trial provides data supporting an early CCTA strategy as an attractive option in women presenting to the ED with symptoms suggestive of acute coronary syndrome. The findings may be explained by lower CAD prevalence and severity in women than men.

Clinical Trial Registration Url: http://www.clinicaltrials.gov. Unique identifier: NCT01084239.

Citing Articles

Diagnostic Performance of Coronary Tomography Angiography and Serial Measurements of Sensitive Cardiac Troponin in Patients With Chest Pain and Intermediate Risk for Cardiovascular Events.

de Matos Soeiro A, Biselli B, Leal T, Bossa A, Cesar M, Jallad S Arq Bras Cardiol. 2022; 118(5):894-902.

PMID: 35137790 PMC: 9368885. DOI: 10.36660/abc.20210006.

Coronary CT angiography for suspected acute coronary syndrome: sex-associated differences.

Arslan M, Schaap J, Moelker A, Rood P, Boersma E, Nieman K Neth Heart J. 2021; 29(10):518-524.

PMID: 34357558 PMC: 8455783. DOI: 10.1007/s12471-021-01607-1.

Coronary Computed Tomography Angiography: Enhancing Risk Stratification and Diagnosis of Cardiovascular Disease in Women.

Karnib S, Chinnaiyan K Curr Treat Options Cardiovasc Med. 2019; 21(10):62.

PMID: 31584125 DOI: 10.1007/s11936-019-0760-1.

Sex differences in coronary artery plaque composition detected by coronary computed tomography: quantitative and qualitative analysis.

Plank F, Beyer C, Friedrich G, Wildauer M, Feuchtner G Neth Heart J. 2019; 27(5):272-280.

PMID: 30734147 PMC: 6470243. DOI: 10.1007/s12471-019-1234-5.

The diagnosis of coronary plaque stability by multi-slice computed tomography coronary angiography.

Song F, Zhou J, Zhou J, Shi Y, Zeng M, Zhang Z J Thorac Dis. 2018; 10(4):2365-2376.

PMID: 29850142 PMC: 5949511. DOI: 10.21037/jtd.2018.04.43.

References

Goldstein J, Chinnaiyan K, Abidov A, Achenbach S, Berman D, Hayes S . The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial. J Am Coll Cardiol. 2011; 58(14):1414-22. DOI: 10.1016/j.jacc.2011.03.068. View

Hoffmann U, Truong Q, Fleg J, Goehler A, Gazelle S, Wiviott S . Design of the Rule Out Myocardial Ischemia/Infarction Using Computer Assisted Tomography: a multicenter randomized comparative effectiveness trial of cardiac computed tomography versus alternative triage strategies in patients with acute chest pain.... Am Heart J. 2012; 163(3):330-8, 338.e1. PMC: 3736358. DOI: 10.1016/j.ahj.2012.01.028. View

Miller J, Rochitte C, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I . Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med. 2008; 359(22):2324-36. DOI: 10.1056/NEJMoa0806576. View

Budoff M, Dowe D, Jollis J, Gitter M, Sutherland J, Halamert E . Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment.... J Am Coll Cardiol. 2008; 52(21):1724-32. DOI: 10.1016/j.jacc.2008.07.031. View

Bamberg F, Truong Q, Blankstein R, Nasir K, Lee H, Rogers I . Usefulness of age and gender in the early triage of patients with acute chest pain having cardiac computed tomographic angiography. Am J Cardiol. 2009; 104(9):1165-70. PMC: 2765413. DOI: 10.1016/j.amjcard.2009.06.029. View

Gerber T, Carr J, Arai A, Dixon R, Ferrari V, Gomes A . Ionizing radiation in cardiac imaging: a science advisory from the American Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on.... Circulation. 2009; 119(7):1056-65. DOI: 10.1161/CIRCULATIONAHA.108.191650. View

Hoffmann U, Truong Q, Schoenfeld D, Chou E, Woodard P, Nagurney J . Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med. 2012; 367(4):299-308. PMC: 3662217. DOI: 10.1056/NEJMoa1201161. View

Mieres J, Shaw L, Arai A, Budoff M, Flamm S, Hundley W . Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: Consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention.... Circulation. 2005; 111(5):682-96. DOI: 10.1161/01.CIR.0000155233.67287.60. View

Achenbach S, Marwan M, Ropers D, Schepis T, Pflederer T, Anders K . Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J. 2009; 31(3):340-6. DOI: 10.1093/eurheartj/ehp470. View

10.

Einstein A, Henzlova M, Rajagopalan S . Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA. 2007; 298(3):317-23. DOI: 10.1001/jama.298.3.317. View

11.

Meijboom W, Meijs M, Schuijf J, Cramer M, Mollet N, van Mieghem C . Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol. 2008; 52(25):2135-44. DOI: 10.1016/j.jacc.2008.08.058. View

12.

Hou Y, Xu S, Guo W, Vembar M, Guo Q . The optimal dose reduction level using iterative reconstruction with prospective ECG-triggered coronary CTA using 256-slice MDCT. Eur J Radiol. 2012; 81(12):3905-11. DOI: 10.1016/j.ejrad.2012.06.022. View

13.

Lloyd-Jones D, Adams R, Brown T, Carnethon M, Dai S, de Simone G . Executive summary: heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation. 2010; 121(7):948-54. DOI: 10.1161/CIRCULATIONAHA.109.192666. View

14.

Schlett C, Banerji D, Siegel E, Bamberg F, Lehman S, Ferencik M . Prognostic value of CT angiography for major adverse cardiac events in patients with acute chest pain from the emergency department: 2-year outcomes of the ROMICAT trial. JACC Cardiovasc Imaging. 2011; 4(5):481-91. PMC: 3220274. DOI: 10.1016/j.jcmg.2010.12.008. View

15.

Litt H, Gatsonis C, Snyder B, Singh H, Miller C, Entrikin D . CT angiography for safe discharge of patients with possible acute coronary syndromes. N Engl J Med. 2012; 366(15):1393-403. DOI: 10.1056/NEJMoa1201163. View

16.

Ghoshhajra B, Engel L, Major G, Goehler A, Techasith T, Verdini D . Evolution of coronary computed tomography radiation dose reduction at a tertiary referral center. Am J Med. 2012; 125(8):764-72. PMC: 6849692. DOI: 10.1016/j.amjmed.2011.10.036. View

17.

Earls J, Berman E, Urban B, Curry C, Lane J, Jennings R . Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose. Radiology. 2008; 246(3):742-53. DOI: 10.1148/radiol.2463070989. View

18.

Min J, Dunning A, Lin F, Achenbach S, Al-Mallah M, Budoff M . Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International.... J Am Coll Cardiol. 2011; 58(8):849-60. DOI: 10.1016/j.jacc.2011.02.074. View

19.

Mosca L, Mochari-Greenberger H, Dolor R, Newby L, Robb K . Twelve-year follow-up of American women's awareness of cardiovascular disease risk and barriers to heart health. Circ Cardiovasc Qual Outcomes. 2010; 3(2):120-7. PMC: 2956447. DOI: 10.1161/CIRCOUTCOMES.109.915538. View

20.

Chen M, Shanbhag S, Arai A . Submillisievert median radiation dose for coronary angiography with a second-generation 320-detector row CT scanner in 107 consecutive patients. Radiology. 2013; 267(1):76-85. PMC: 3606544. DOI: 10.1148/radiol.13122621. View