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Age- and gender-specific differences in the prognostic value of CT coronary angiography
  1. Kai Hang Yiu1,2,
  2. Fleur R de Graaf1,
  3. Joanne D Schuijf1,
  4. Jacob M van Werkhoven1,2,
  5. Nina Ajmone Marsan1,
  6. Caroline E Veltman1,
  7. Albert de Roos3,
  8. Aju Pazhenkottil4,
  9. Lucia J Kroft3,
  10. Eric Boersma5,
  11. Bernhard Herzog4,
  12. Melissa Leung6,
  13. Erica Maffei7,
  14. Dominic Y Leung6,
  15. Philipp A Kaufmann4,8,
  16. Filippo Cademartiri7,
  17. Jeroen J Bax1,
  18. J Wouter Jukema1,2
  1. 1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
  3. 3Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
  4. 4Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
  5. 5Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
  6. 6Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia
  7. 7Department of Radiology and Cardiology, Azienda Ospedaliero-Universitaria, Parma, Italy
  8. 8Zurich Integrative Human Physiology, University of Zurich, Zurich, Switzerland
  1. Correspondence to Dr J Wouter Jukema, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; j.w.jukema{at}lumc.nl

Abstract

Objective To evaluate the potential age- and gender-specific differences in the incidence and prognostic value of coronary artery disease (CAD) in patients undergoing CT coronary angiography (CTA).

Design and patients In this multicentre prospective registry study, 2432 patients (mean age 57±12, 56% male) underwent CTA for suspected CAD. Patients were stratified into four groups according to age <60 or ≥60 years and, male or female gender.

Main outcome measures A composite end point of cardiac death and non-fatal myocardial infarction.

Results CTA results were normal in 991 (41%) patients, showed non-significant CAD in 761 (31%) patients and significant CAD in the remaining 680 (28%) patients. During follow-up (median 819 days, 25–75th centile 482–1142) a cardiovascular event occurred in 59 (2.4%) patients. The annualised event rate was 1.1% in the total population (men=1.3% and women=0.9%). In patients aged <60 years, the annualised event rate of male and female patients was 0.6% and 0.5%, respectively. Among patients aged ≥60 years the annualised event rate was 1.9% in male and 1.1% in female patients. Observations on CTA predicted events in male patients, both age <60 and ≥60 years and in female patients age ≥60 years (log-rank test in all groups, p<0.01). However, CTA provided limited prognostic value in female patients aged <60 years (log-rank test, p=0.45).

Conclusions After age and gender stratification, CTA findings were shown to be of limited predictive value in female patients aged <60 years as compared with male patients at any age and female patients aged ≥60 years.

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Footnotes

  • Funding KHY receives reseach grants from the Hong Kong Heart Foundation. JWJ receives research grants from and was a speaker at meetings sponsored by Astellas, AstraZeneca, Biotronic, Boston Scientific, Bristol-Myers Squibb, Cordis, Daiichi Sankyo, Eli Lilly and Company, Medtronic, Merck-Schering Plough, Pfizer, Orbus Neich, Novartis, Roche, Servier, the Netherlands Heart Foundation, the Interuniversity Cardiology Institute of the Netherlands and the European Community framework KP7 program. JJB receives grants from Biotronik, BMS medical imaging, Boston Scientific, Edwards Lifesciences, GE Healthcare, Medtronic and St Jude Medical. JvW is financially supported by a research grant from the Netherlands Society of Cardiology (Utrecht, The Netherlands). PAK is supported by a grant from the Swiss National Science Foundation (Berne, Switzerland) (SNSF-professorship grant nr.PPOOA-114706), The remaining authors: None.

  • Competing interests None.

  • Ethics approval This study was approved by the local ethics committees in all participating centres and all patients provided informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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