Is there a gender difference in non-invasive coronary imaging? Multislice computed tomography for noninvasive detection of coronary stenoses

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Abstract

Background
Multislice computed tomography (MSCT) coronary angiography is the foremost alternative to invasive coronary angiography.

Methods
We sought to compare the diagnostic accuracy of MSCT in female and male patients with suspected coronary disease. Altogether 50 women and 95 men underwent MSCT with 0.5 mm detector collimation. Coronary artery stenoses of at least 50% on conventional coronary angiography were considered significant.

Results
The coronary vessel diameters of all four main coronary artery branches were significantly larger in men than in women. The diagnostic accuracy of MSCT in identifying patients with coronary artery disease was significantly lower for women (72%) compared with men (89%, br < 0.05). Also sensitivity (70% vs. 95%), positive predictive value (64% vs. 93%), and the rate of non-diagnostic examinations (14 versus 4%, all: br < 0.05) were significantly worse for women. The effective radiation dose of MSCT coronary angiography was significantly higher in the examination of women (13.7 &brlusmn; 1.2 mSv) than of men (11.7 &brlusmn; 0.9 mSv, br < 0.001), mainly as a result of the fact that the radiosensitive female breast (contributing 24.5% of the dose in women) is in the x-ray path.

Conclusion
Non-invasive coronary angiography with MSCT might be less accurate and sensitive for women than men. Also, women are exposed to a significantly higher effective radiation dose than men.

Pages

Background

Since conventional coronary angiography exposes the patients not only to rare (1.7%) but relevant risks like bleeding, stroke, infarction, and dissections but also has a considerable mortality of 0.11% [ 1] a noninvasive alternative would be an important advance. At present the foremost alternative to conventional coronary angiography is multislice computed tomography (MSCT) [2-7] which has a high spatial (0.5 to 0.75 mm slice thickness) and temporal resolution (140 to 200 ms acquisition window). To reliably exclude the presence of coronary artery stenoses is the primary aim of noninvasive coronary angiography using MSCT [8]. However, MSCT exposes the patient to radiation and requires intravenous injection of a contrast medium. For these reasons and since gender differences play a prominent role in cardiac imaging [9] and therapy [10] it appears worthwhile to examine gender differences of MSCT in detail before routine application of this technology. Thus, we prospectively analyzed the diagnostic accuracy of MSCT in women and men as part of an investigator-initiated study on noninvasive coronary angiography [11].

Methods
Study population
A total of 126 patients (Table 1) with suspected coronary artery disease and without contraindications (creatinine above 1.5 mg/dL, allergy to iodinated contrast agents) underwent MSCT and conventional coronary angiography as part of an investigator-initiated trial [11] in which all patients are included in the analysis (intention-to-diagnose design) [12]. Exclusion criteria for the study were age below 40 years (as requested by the Federal Department for Radiation Protection), nonsinus rhythm, previous conventional coronary angiography, pregnancy, breast-feeding, orthopnea, unstable angina, and myocardial infarction. The institutional review board and the Federal Department for Radiation Protection approved the study and all patients gave written informed consent. To increase the amount of female patients available for this comparison (beyond that of the 31 women who were included in the intention-to-diagnose study mentioned above) we included women (19) who underwent CT coronary angiography using 16 detector rows and conventional coronary angiography (both performed before and after CT) at our institution for clinical purposes and included them in the present analysis of gender differences in regards to MSCT coronary angiography (50 women and 95 men)./>/>/>/>

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