Abstract Aims The relative benefits of computed tomography coronary angiography (CTCA)-guided management in women and men with suspected angina due to coronary heart disease (CHD) are uncertain. Methods and results In this post hoc analysis of an open-label parallel-group multicentre trial, we recruited 4146 patients referred for assessment of suspected angina from 12 cardiology clinics across the UK. We randomly assigned (1:1) participants to standard care alone or standard care plus CTCA. Fewer women had typical chest pain symptoms (n = 582, 32.0%) when compared with men (n = 880, 37.9%; P < 0.001). Amongst the CTCA-guided group, more women had normal coronary arteries [386 (49.6%) vs. 263 (26.2%)] and less obstructive CHD [105 (11.5%) vs. 347 (29.8%)]. A CTCA-guided strategy resulted in more women than men being reclassified as not having CHD {19.2% vs. 13.1%; absolute risk difference, 5.7 [95% confidence interval (CI): 2.7–8.7, P < 0.001]} or having angina due to CHD [15.0% vs. 9.0%; absolute risk difference, 5.6 (2.3–8.9, P = 0.001)]. After a median of 4.8 years follow-up, CTCA-guided management was associated with similar reductions in the risk of CHD death or non-fatal myocardial infarction in women [hazard ratio (HR) 0.50, 95% CI 0.24–1.04], and men (HR 0.63, 95% CI 0.42–0.95; Pinteraction = 0.572). Conclusion Following the addition of CTCA, women were more likely to be found to have normal coronary arteries than men. This led to more women being reclassified as not having CHD, resulting in more downstream tests and treatments being cancelled. There were similar prognostic benefits of CTCA for women and men.

中文翻译：

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稳定型胸痛患者的性别关联和计算机断层扫描冠状动脉造影引导的治疗

摘要 目的 对于疑似冠心病 (CHD) 引起的心绞痛的女性和男性，计算机断层扫描冠状动脉造影 (CTCA) 指导治疗的相对益处尚不确定。方法和结果 在这项开放标签平行组多中心试验的事后分析中，我们招募了来自英国 12 家心脏病诊所的 4146 名患者，他们被转诊接受疑似心绞痛评估。我们将参与者随机分配 (1:1) 单独接受标准护理或标准护理加 CTCA。与男性相比，出现典型胸痛症状的女性较少（n = 582，32.0%）（n = 880，37.9%；P < 0.001）。在 CTCA 指导组中，冠状动脉正常的女性较多 [386 例 (49.6%) 对比 263 例 (26.2%)]，阻塞性 CHD 较少[105 例 (11.5%) 对比 347 例 (29.8%)]。CTCA 指导策略导致更多女性被重新分类为无 CHD（19.2% vs. 13.1%；绝对风险差异，5.7 [95% 置信区间 (CI)：2.7–8.7，P < 0.001]} 或因 CHD 引起心绞痛 [15.0% vs. 9.0%；绝对风险差异，5.6（2.3-8.9，P = 0.001）]。经过中位 4.8 年的随访后，CTCA 指导的治疗与女性 CHD 死亡或非致命性心肌梗死风险的类似降低相关[风险比 (HR) 0.50，95% CI 0.24–1.04]，并且男性（HR 0.63，95% CI 0.42–0.95；Pinteraction = 0.572）。结论 添加 CTCA 后，女性比男性更有可能发现冠状动脉正常。这导致更多的女性被重新归类为没有先心病，导致更多下游测试和治疗被取消。CTCA 对女性和男性的预后益处相似。