CTCA of ‘limited prognostic value’ in women under 60 years
MedWire News: Computed tomography coronary angiography (CTCA) is of limited prognostic value in women younger than 60 years of age, study findings suggest.
J Wouter Jukema and colleagues found that CTCA was a strong predictor for CV events in men of any age, and women aged 60 years or older, but did not have significant prognostic value in women under the age of 60.
Their analysis involved 2432 patients who underwent CTCA for suspected CAD. All patients were stratified according to their age (<60 years or ≥60 years) and gender.
The findings revealed that CTCA results were normal (no identifiable plaque or minimal wall irregularities) in 991 (41%) patients, showed nonobstructive CAD (<50% luminal narrowing) in 761 (31%) patients, and obstructive CAD (≥50% luminal narrowing) in 680 (28%) patients.
During a median follow-up period of 819 days, nonfatal myocardial infarction (MI) occurred in 34 (1.4%) patients and CV mortality in 25 (1.0%) patients. There was no significant difference in the primary composite endpoint of these outcomes between men and women across both age groups.
Gender-specific analysis revealed that CTCA was predictive of the composite endpoint for both men and women (p<0.01 for both).
In men under the age of 60 years, CTCA was a significant predictor of CV events (nonfatal MI and CV mortality; p<0.01).
Furthermore, obstructive CAD was a more significant predictor of the composite endpoint of nonfatal MI and CV death for both age groups than was a normal CTCA result (p<0.01). Nonobstructive CTCA was not a significant predictor of either component of the composite endpoint.
CTCA significantly predicted combined nonfatal MI and CV mortality in women over the age of 60 years (p<0.01). Moreover, both nonobstructive and obstructive CAD were predictors of the composite endpoint compared with normal CTCA (p<0.01).
However, in women aged under 60 years, CTCA was not significantly predictive of nonfatal MI or mortality, and neither the presence of nonobstructive nor obstructive CAD compared with normal CAD predicted these events in this group.
Jukema and team suggest that cardiovascular risk factors, such as diabetes, could have greater prognostic impact in women than the presence of CAD alone.
"Accordingly, while CTCA may be a valuable technique to rule out CAD and avoid unnecessary invasive coronary angiography, its prognostic value appears to be limited in women aged under 60 years," they conclude.
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By Piriya Mahendra