Abstract
AimThe optimal diagnostic test in the work-up of suspected acute coronary syndrome (ACS) may differ between men and women. The aim of this study was to compare sex-associated differences between using a diagnostic strategy including early coronary computed tomography angiography (CCTA) and standard of care (SOC).MethodsIn total, 500 patients who presented with symptoms suggestive of ACS at the emergency department were randomised between a diagnostic strategy supplemented with early CCTA and SOC.ResultsWomen were generally older than men (mean ± standard deviation 56 ± 10 vs 53 ± 10 years, p < 0.01) and were less often admitted to hospital (33% vs 44%, p = 0.02). Obstructive coronary artery disease on CCTA (> 50% luminal narrowing) was less frequently seen in women (14% vs 26%, p = 0.02), and ACS was diagnosed less often in women (5% vs 10%, p = 0.03). Women underwent less outpatient testing when early CCTA was used in the emergency department evaluation of suspected ACS (p = 0.008).ConclusionWomen had a lower incidence of obstructive CAD on CCTA and were less often admitted to hospital than men. They were subjected to less outpatient testing when early CCTA was used in the emergency department evaluation of suspected ACS.Supplementary InformationThe online version of this article (10.1007/s12471-021-01607-1) contains supplementary material, which is available to authorized users.
Highlights
There are distinct pathophysiological differences in coronary artery disease (CAD) between men and What’s new?In this study in patients with suspected acute coronary syndrome (ACS), women had a lower incidence of obstructive coronary artery disease on coronary computed tomography angiography (CCTA) than men
Women underwent less outpatient testing when early CCTA was used in the emergency department evaluation of suspected ACS (p = 0.008)
Women underwent less outpatient testing when early CCTA was used in the emergency department evaluation of suspected ACS than men
Summary
There are distinct pathophysiological differences in coronary artery disease (CAD) between men and What’s new?. In this study in patients with suspected acute coronary syndrome (ACS), women had a lower incidence of obstructive coronary artery disease on coronary computed tomography angiography (CCTA) than men. Women underwent less outpatient testing when early CCTA was used in the emergency department evaluation of suspected ACS than men. Men are more likely to have obstructive epicardial CAD, while women are more prone to have coronary microvascular dysfunction [1]. Disease perception may differ, both from the physician’s perspective—leading to sex-specific referral bias—and the patient’s own perception of chest discomfort, both of which can result in underrecognition of the burden of CAD in women [2]. The optimal diagnostic test in the work-up of suspected acute coronary syndrome (ACS) may be different for men and women [3]
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