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Sex associations and computed tomography coronary angiography-guided management in patients with stable chest pain

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dc.contributor.author Mangion, Kenneth
dc.contributor.author Adamson, Philip D.
dc.contributor.author Williams, Michelle C.
dc.contributor.author Hunter, Amanda
dc.contributor.author Pawade, Tania A.
dc.contributor.author Shah, Anoop S. V.
dc.contributor.author Lewis, Stephanie
dc.contributor.author Boon, Nicholas A.
dc.contributor.author Flather, Marcus
dc.contributor.author Forbes, John F.
dc.contributor.author McLean, Scott
dc.contributor.author Roditi, Giles
dc.contributor.author van Beek, Edwin J.R.
dc.contributor.author Timmis, Adam D.
dc.contributor.author Newby, David E.
dc.contributor.author McAllister, David A.
dc.contributor.author Berry, Colin
dc.date.accessioned 2020-04-20T08:05:28Z
dc.date.available 2020-04-20T08:05:28Z
dc.date.issued 2020
dc.identifier.uri http://hdl.handle.net/10344/8736
dc.description peer-reviewed en_US
dc.description.abstract The relative benefits of computed tomography coronary angiography (CTCA)-guided management in women and men with suspected angina due to coronary heart disease (CHD) are uncertain. Methods and results In this post hoc analysis of an open-label parallel-group multicentre trial, we recruited 4146 patients referred for assessment of suspected angina from 12 cardiology clinics across the UK. We randomly assigned (1:1) participants to standard care alone or standard care plus CTCA. Fewer women had typical chest pain symptoms (n = 582, 32.0%) when compared with men (n = 880, 37.9%; P < 0.001). Amongst the CTCA-guided group, more women had normal coronary arteries [386 (49.6%) vs. 263 (26.2%)] and less obstructive CHD [105 (11.5%) vs. 347 (29.8%)]. A CTCAguided strategy resulted in more women than men being reclassified as not having CHD {19.2% vs. 13.1%; absolute risk difference, 5.7 [95% confidence interval (CI): 2.7–8.7, P < 0.001]} or having angina due to CHD [15.0% vs. 9.0%; absolute risk difference, 5.6 (2.3–8.9, P = 0.001)]. After a median of 4.8 years follow-up, CTCA-guided management was associated with similar reductions in the risk of CHD death or non-fatal myocardial infarction in women [hazard ratio (HR) 0.50, 95% CI 0.24–1.04], and men (HR 0.63, 95% CI 0.42–0.95; Pinteraction = 0.572).Conclusion Following the addition of CTCA, women were more likely to be found to have normal coronary arteries than men. This led to more women being reclassified as not having CHD, resulting in more downstream tests and treatments being cancelled. There were similar prognostic benefits of CTCA for women and men. en_US
dc.language.iso eng en_US
dc.publisher Oxford University Press en_US
dc.relation WT103782AIA en_US
dc.relation.ispartofseries European Heart Journal;41,pp. 1337–1345
dc.subject Coronary heart disease en_US
dc.subject Angina en_US
dc.subject Gender en_US
dc.subject CTCA en_US
dc.title Sex associations and computed tomography coronary angiography-guided management in patients with stable chest pain en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.identifier.doi 10.1093/eurheartj/ehz903
dc.contributor.sponsor Scottish Government Health and Social Care Directorates en_US
dc.relation.projectid RE/13/3/30183 en_US
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US
dc.internal.rssid 2951358
dc.internal.rssid 2951358


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