在评估稳定型胸痛时，心脏计算机断层扫描与功能测试相比的性别差异：多中心随机CRESCENT试验（疑似冠状动脉疾病的钙成像和选择性CT血管造影与功能测试的比较）的亚分析
Sex Differences in the Performance of Cardiac Computed Tomography Compared With Functional Testing in Evaluating Stable Chest Pain: Subanalysis of the Multicenter, Randomized CRESCENT Trial (Calcium Imaging and Selective CT Angiography in Comparison to Functional Testing for Suspected Coronary Artery Disease).
作者信息
Lubbers Marisa, Coenen Adriaan, Bruning Tobias, Galema Tjebbe, Akkerhuis Jurgen, Krenning Boudewijn, Musters Paul, Ouhlous Mohamed, Liem Ahno, Niezen Andre, Dedic Admir, van Domburg Ron, Hunink Miriam, Nieman Koen
机构信息
From the Department of Cardiology (M.L., A.C., T.G., P.M., A.D., R.v.D., K.N.) and Department of Radiology (M.L., A.C., M.O., A.D., M.H., K.N.), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiology (T.B.) and Department of Radiology (A.N.), Maasstad Hospital, Rotterdam, The Netherlands; Department of Cardiology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands (J.A., A.L.); Department of Cardiology, Haven Hospital, Rotterdam, The Netherlands (B.K.); and Stanford Cardiovascular Institute, Stanford University, CA (K.N.).
出版信息
Circ Cardiovasc Imaging. 2017 Feb;10(2). doi: 10.1161/CIRCIMAGING.116.005295.
BACKGROUND
Cardiac computed tomography (CT) represents an alternative diagnostic strategy for women with suspected coronary artery disease, with potential benefits in terms of effectiveness and cost-efficiency.
METHODS AND RESULTS
The CRESCENT trial (Calcium Imaging and Selective CT Angiography in Comparison to Functional Testing for Suspected Coronary Artery Disease) prospectively randomized 350 patients with stable angina (55% women; aged 55±10 years), mostly with an intermediate coronary artery disease probability, between cardiac CT and functional testing. The tiered cardiac CT protocol included a calcium scan followed by CT angiography if the Agatston calcium score was between 1 and 400. Patients with test-specific contraindications were not excluded from study participation. Sex differences were studied as a prespecified subanalysis. Enrolled women presented more frequently with atypical chest pain and had a lower pretest probability of coronary artery disease compared with men. Independently of these differences, cardiac CT led in both sexes to a fast final diagnosis when compared with functional testing, although the effect was larger in women (P interaction=0.01). The reduced need for further testing after CT, compared with functional testing, was most evident in women (P interaction=0.009). However, no sex interaction was observed with respect to changes in angina and quality of life, cumulative diagnostic costs, and applied radiation dose (all P interactions≥0.097).
CONCLUSIONS
Cardiac CT is more efficient in women than in men in terms of time to reach the final diagnosis and downstream testing. However, overall clinical outcome showed no significant difference between women and men after 1 year.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01393028.
背景
心脏计算机断层扫描（CT）是疑似冠心病女性的一种替代诊断策略，在有效性和成本效益方面具有潜在优势。
方法与结果
CRESCENT试验（疑似冠状动脉疾病的钙成像和选择性CT血管造影与功能测试比较）前瞻性地将350例稳定型心绞痛患者（55%为女性；年龄55±10岁）随机分为心脏CT组和功能测试组，这些患者大多具有中等冠状动脉疾病概率。分层心脏CT方案包括钙扫描，如果阿加斯顿钙评分在1至400之间，则随后进行CT血管造影。有特定检查禁忌证的患者不排除参与研究。将性别差异作为预先设定的亚组分析进行研究。与男性相比，纳入研究的女性更常出现非典型胸痛，且冠状动脉疾病的预检概率较低。尽管女性的效果更大（P交互作用=0.01），但与功能测试相比，心脏CT在两性中都能更快地得出最终诊断。与功能测试相比，CT后对进一步检查的需求减少在女性中最为明显（P交互作用=0.009）。然而，在心绞痛和生活质量的变化、累积诊断成本以及应用的辐射剂量方面未观察到性别交互作用（所有P交互作用≥0.097）。
结论
在达到最终诊断的时间和下游检查方面，心脏CT对女性比男性更有效。然而，1年后女性和男性的总体临床结局无显著差异。
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