Abstract 491: Effect of Gender on Management of Suspected Coronary Artery Disease After Coronary CT Angiography
Introduction: Diagnosis of coronary artery disease (CAD) in women is challenging due to atypical symptoms as well as lower prevalence of disease and accuracy of noninvasive tests. Women require more additional testing due to equivocal or conflicting noninvasive tests.
Hypothesis: The high diagnostic accuracy of coronary CT angiography (CCTA) may result in negation of gender differences in downstream resource utilization (RU).
Methods: Patients undergoing CCTA and enrolled in a statewide prospective registry with complete 3-month follow-up data were studied. The study group was divided by coronary stenosis of ≤50% or >50% on CCTA. Men and women were compared for baseline demographics, symptoms, coronary risk factors, CAD prevalence and 3-month follow-up data, i.e., stress tests, invasive coronary angiography (ICA), percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), emergency room (ER) cardiac evaluations and hospitalizations as well as major adverse cardiac events (MACE), i.e., acute coronary syndromes and all-cause death.
Results: The study group included 8831 patients (4306, 49% women) with no pre-existing CAD. Prevalence of >50% stenosis was lower in women (13% vs. 21%, p <0.0001). Compared to men, women were older and had more atypical symptoms with lower CAD pre-test likelihood (all p<0.0001). Within each gender, non-obstructive CAD was associated with lower rates of RU (women -13% vs. 44%, men-13% vs. 42%, all p <0.0001) and MACE (women -10% vs. 28%, men -10% vs. 26%, all p <0.0001). Men with ≤50% had slightly higher rates of stress testing (p = 0.003). No significant gender differences were noted in total RU or MACE (Table⇓).
Conclusion: No gender disparities exist in post-CCTA management despite a higher pre-test symptom burden in women. Importantly, non-obstructive CAD on CCTA is equally associated with lower RU and short-term MACE in both sexes. Men and women are equally likely to incur higher RU if >50% stenosis is noted on CCTA.