计算机断层扫描冠状动脉造影术在低至中度冠心病风险的女性和男性中的准确性。
Computed tomography coronary angiography accuracy in women and men at low to intermediate risk of coronary artery disease.
机构信息
Department of Radiology, Erasmus MC, Room Ca207a, 's-Gravendijkwal 230, P.O. Box 2040, 3015 CE, Rotterdam, The Netherlands.
出版信息
Eur Radiol. 2012 Nov;22(11):2415-23. doi: 10.1007/s00330-012-2503-5. Epub 2012 Jun 6.
OBJECTIVES
To investigate the diagnostic accuracy of CT coronary angiography (CTCA) in women at low to intermediate pre-test probability of coronary artery disease (CAD) compared with men.
METHODS
In this retrospective study we included symptomatic patients with low to intermediate risk who underwent both invasive coronary angiography and CTCA. Exclusion criteria were previous revascularisation or myocardial infarction. The pre-test probability of CAD was estimated using the Duke risk score. Thresholds of less than 30 % and 30-90 % were used for determining low and intermediate risk, respectively. The diagnostic accuracy of CTCA in detecting obstructive CAD (≥50 % lumen diameter narrowing) was calculated on patient level. P < 0.05 was considered significant.
RESULTS
A total of 570 patients (46 % women [262/570]) were included and stratified as low (women 73 % [80/109]) and intermediate risk (women 39 % [182/461]). Sensitivity, specificity, PPV and NPV were not significantly different in and between women and men at low and intermediate risk. For women vs. men at low risk they were 97 % vs. 100 %, 79 % vs. 90 %, 80 % vs. 80 % and 97 % vs. 100 %, respectively. For intermediate risk they were 99 % vs. 99 %, 72 % vs. 83 %, 88 % vs. 93 % and 98 % vs. 99 %, respectively.
CONCLUSION
CTCA has similar diagnostic accuracy in women and men at low and intermediate risk.
KEY POINTS
• Coronary artery disease (CAD) is increasingly investigated by computed tomography angiography (CTCA). • CAD detection or exclusion by CTCA is not different between sexes. • CTCA diagnostic accuracy was similar between low and intermediate risk sex-specific-groups. • CTCA rarely misses obstructive CAD in low-intermediate risk women and men. • CAD yield by invasive coronary angiography after positive CTCA is similar between sex-risk-specific groups.
目的
研究 CT 冠状动脉造影（CTCA）在低至中危前冠状动脉疾病（CAD）预测概率的女性患者中的诊断准确性，并与男性进行比较。
方法
本回顾性研究纳入了同时接受有创冠状动脉造影和 CTCA 检查的有症状、低至中危患者。排除标准为既往血运重建或心肌梗死。CAD 的前测概率使用 Duke 风险评分进行评估。分别采用<30%和 30-90%的阈值来确定低危和中危。在患者水平上计算 CTCA 检测阻塞性 CAD（管腔直径狭窄≥50%）的诊断准确性。P 值<0.05 认为具有统计学意义。
结果
共纳入 570 例患者（女性 46%[262/570]），并分为低危（女性 73%[80/109]）和中危（女性 39%[182/461]）。在低危和中危患者中，女性和男性的敏感度、特异度、阳性预测值和阴性预测值在组内和组间均无显著差异。女性与男性相比，低危患者的敏感度分别为 97%和 100%，特异度分别为 79%和 90%，阳性预测值分别为 80%和 80%，阴性预测值分别为 97%和 100%。中危患者的敏感度分别为 99%和 99%，特异度分别为 72%和 83%，阳性预测值分别为 88%和 93%，阴性预测值分别为 98%和 99%。
结论
CTCA 在低危和中危女性和男性中的诊断准确性相似。
关键点
越来越多的人通过计算机断层血管造影（CTCA）来检查冠状动脉疾病（CAD）。
CTCA 对 CAD 的检测或排除在性别之间没有差异。
在低危和中危的性别特定组中，CTCA 的诊断准确性相似。
CTCA 很少会漏诊低危到中危的女性和男性的阻塞性 CAD。
阳性 CTCA 后行有创冠状动脉造影的 CAD 检出率在性别风险特定组之间相似。
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