Abstract 12596: Women Benefit Most from Early CCTA Compared to Standard ED Evaluation for Acute Chest Pain: The ROMICAT II Trial

Abstract

Objective: To determine the influence of gender on the efficiency of early cardiac computed tomographic angiography (CCTA) versus standard emergency department (ED) evaluation in patients with acute chest pain (ACP).

Methods: In this multicenter controlled trial, we randomized 1000 patients (47% women) 40-74 years old with symptoms suggestive of acute coronary syndrome (ACS) but without ischemic ECG changes or initial positive troponin to either an early CCTA (48% women) or standard ED evaluation (46% women). In this analysis, we compare gender differences in the primary endpoint of length of stay (LOS); secondary effectiveness endpoints of ED discharge, hospital admission, and 28-day downstream testing (defined as ≥2 diagnostic tests) rates; and safety endpoints of cumulative radiation dose, missed ACS, and major adverse cardiac events (MACE) at 28 days.

Results: Women were slightly older than men (56±8 vs 53±8 years, p<0.0001) and had lower ACS rates (2.6% vs 11.8%, p<0.0001). Table 1 shows gender differences in endpoints between strategies: women had a greater reduction in LOS, lower hospital admission rate, and lesser increase in cumulative radiation dose than men when CCTA was implemented early as compared to standard ED evaluation (all p-interactions≤0.016). The gender difference in mean or median LOS persisted after adjustment for baseline differences including age, demographics, cardiac risk factors, and ACS rate (both p-interactions<0.03). There was no missed ACS for either gender. Women had more normal CCTA than men (58% vs 37%, p<0.0001) but had similar normalcy rates for functional testing (80.7% vs. 81.1%, p=1.0).

Conclusions: In the ED evaluation of patients with ACP, women undergoing CCTA have shorter LOS, fewer hospital admissions, and lower cumulative radiation dose compared to men. Our findings may be explained by more normal CCTA in women than men. Further analysis will assess whether these findings are common to any low prevalence group.