Cardiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
Radiology, Edinburgh Napier University, Edinburgh, UK.
Open Heart. 2021 Jun;8(1). doi: 10.1136/openhrt-2021-001672.
We surveyed UK practice of National Institute for Health and Care Excellence (NICE) "Recent onset chest pain" guidance (CG95, 2016), stratified by sex. We looked for sex-related differences in referral to computed tomographic coronary angiography (CTCA) and subsequent functional imaging (FI), invasive coronary angiography (ICA) and revascularisation.
This was a prospective analysis of CTCA practice in 8 UK centres between 2018 and 2020. Coronary artery disease (CAD) was recorded with the CAD-reporting and data system. Local electronic records/archiving/communication systems were used to collect data regarding subsequent FI, ICA and revascularisation.
2301 women, 2326 men underwent CTCA; women were older (58±11 vs 55±12 years, p<0.001) but more likely to have normal coronary arteries (46% (1047) vs 29% (685); p<0.001) and less likely to have severe stenosis (7% (169) vs 13% (307); p<0.001). FI was used less for 4% (93) women, 5% (108) men; ICA was also used less for women (8% (182) vs 14% (321)), as was revascularisation (4% (83) vs 8% (177), p<0.001 for all), including those with ≥moderate CTCA stenosis undergoing ICA (53% (79) vs 61% (166); p<0.001).
Women referred for a NICE CG95 (2016) CTCA are more likely to have normal coronary arteries and men more likely to have CAD. More men than women will then undergo ICA and revascularisation even after adjustments for CTCA disease severity. Raised awareness of these inequalities may improve contemporary chest pain care.
我们对英国国家卫生与保健优化研究所（NICE）“近期发作胸痛”指南（CG95，2016 年）的实践情况进行了调查，并按性别进行了分层。我们研究了在 CTCA 检查后转诊进行计算机断层冠状动脉成像（CTCA）和后续功能成像（FI）、经皮冠状动脉介入治疗（ICA）和血运重建方面的性别差异。
这是一项对 2018 年至 2020 年期间英国 8 个中心 CTCA 实践情况的前瞻性分析。使用 CAD 报告和数据系统记录冠状动脉疾病（CAD）。使用当地的电子记录/存档/通信系统收集关于后续 FI、ICA 和血运重建的数据。
2301 名女性和 2326 名男性接受了 CTCA 检查；女性年龄较大（58±11 岁比 55±12 岁，p<0.001），但更有可能出现正常冠状动脉（46%（1047）比 29%（685），p<0.001）和较少出现严重狭窄（7%（169）比 13%（307），p<0.001）。4%（93）名女性和 5%（108）名男性使用 FI 较少；女性也较少接受 ICA（8%（182）比 14%（321）），以及较少接受血运重建（4%（83）比 8%（177），所有这些差异均有统计学意义），包括那些 CTCA 狭窄程度≥中度的患者接受 ICA（53%（79）比 61%（166），p<0.001）。
根据 NICE CG95（2016 年）指南接受 CTCA 检查的女性更有可能出现正常冠状动脉，而男性更有可能患有 CAD。即使考虑到 CTCA 疾病严重程度的调整，接受 ICA 和血运重建的男性也多于女性。提高对这些不平等现象的认识可能会改善当代胸痛治疗。
