Abstract
This study sought to investigate gender differences in clinical presentation, presence, and extent of coronary artery disease (CAD), and all-cause mortality in patients with stable chest pain who underwent coronary computed tomography angiography (CCTA). Patients who visited the fast-track outpatient clinic of the Erasmus Medical Center and underwent CCTA were analyzed. Clinical characteristics of chest pain, CAD on CCTA, coronary artery calcium scores, and survival were collected retrospectively and compared between men and women. Logistic regression was used to identify independent risk factors for the presence of CAD and Cox regression for all-cause mortality. In 1,835 included patients, 966 (52.6%) were female. Men and women were similar in age (55 vs 56years). Compared with men, women had a lower frequency of typical pain (22.8% vs 31.1%, p<0.001), lower prevalence of significant CAD (22.2% vs 38.1%, p<0.001), and lower coronary artery calcium scores (p <0.001). CAD was more prevalent in men than in women with typical pain (67.4% vs 35.9%, p<0.001) and also with nontypical pain (24.9% vs 18.1%, p=0.002). After adjustment for baseline characteristic, male sex was associated with all-cause mortality (adjusted hazard ratio 1.87, 95% confidence interval 1.25 to 2.80, p=0.002). The additional risk of mortality because of CAD was similar between men and women. Stratifying by typical and nontypical pain, women again had a better prognosis. Our study identifies gender-related differences in characteristics, CCTA-findings, and outcomes for women compared with men presenting for CCTA with chest pain. Women have less CAD and a better prognosis than men, the clinical implications of which require further study.
Highlights
Track outpatient clinic and who underwent coronary computed tomography angiography (CCTA) as a part of routine clinical management
In our study, comprising of a consecutive cohort of patients with stable chest pain who were referred for CCTA, women presented more often with nontypical chest pain than men and had a lower prevalence of confirmed coronary artery disease (CAD) with subsequently lower mortality
Women had a greater burden of angina symptoms than men, having less extensive CAD,[14] which was similar to the lower CAC scores and prevalence of CAD in women as shown in our study, and the survival benefit of women as compared with men
Summary
Track outpatient clinic and who underwent coronary computed tomography angiography (CCTA) as a part of routine clinical management. The fast-track outpatient clinic provides rapid-access cardiology services to deal with the rising number of outpatients and meet the expectations of patients, such as short waiting time, direct evaluation of test results, and immediate therapy if needed.[6]. The purpose of this single-center study was to investigate gender differences in clinical presentation, presence and extent of CAD, and survival in patients with stable chest pain referred for CCTA
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