Computed Tomographic Perfusion Improves Diagnostic Power of Coronary Computed Tomographic Angiography in Women: Analysis of the CORE320 Trial (Coronary Artery Evaluation Using 320-Row Multidetector Computed Tomography Angiography and Myocardial Perfusion) According to Gender
From the Johns Hopkins Hospital and School of Medicine (A.P., A.L.V., J.M.M., A.A.-Z, J.A.C.L.) and Johns Hopkins Bloomberg School of Public Health (A.B., C.C.), Baltimore, MD; National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (A.Y.H., M.Y.C.); Toshiba Medical Systems Corporation, Japan (C.S); Charité Medical School, Humboldt, Berlin, Germany (E.Z., M.D.); Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.); Rigshospitalet, University of Copenhagen, Denmark (K.F.K); St Luke’s International Hospital, Tokyo, Japan (H.N.); and Brigham and Women’s Hospital, Boston, MA (M.F.D.C.).
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Background—Coronary computed tomographic angiography (CTA) and myocardial perfusion imaging (CTP) is a validated approach for detection and exclusion of flow-limiting coronary artery disease (CAD), but little data are available on gender-specific performance of these modalities. In this study, we aimed to evaluate the diagnostic accuracy of combined coronary CTA and CTP in detecting flow-limiting CAD in women compared with men.Methods and Results—Three hundred and eighty-one patients who underwent both CTA-CTP and single-photon emission computed tomography myocardial perfusion imaging preceding invasive coronary angiography as part of the CORE320 multicenter study (Coronary Artery Evaluation Using 320-row Multidetector Computed Tomography Angiography and Myocardial Perfusion) were included in this ancillary study. All 4 image modalities were analyzed in blinded, independent core laboratories. Prevalence of flow-limiting CAD defined by invasive coronary angiography equal to 50% or greater with an associated single-photon emission computed tomography myocardial perfusion imaging defect was 45% (114/252) and 23% (30/129) in males and females, respectively. Patient-based diagnostic accuracy defined by the area under the receiver operating curve for detecting flow-limiting CAD by CTA alone in females was 0.83 (0.75–0.89) and for CTA-CTP was 0.92 (0.86–0.97; P=0.003) compared with men where the area under the receiver operating curve for detecting flow-limiting CAD by CTA alone was 0.82 (0.77–0.87) and for CTA-CTP was 0.84 (0.80–0.89; P=0.29).Conclusions—The combination of CTA-CTP was performed similarly in men and women for identifying flow-limiting coronary stenosis; however, in women, CTP had incremental value over CTA alone, which was not the case in men.Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00934037.