Anoeshka Shashikala Dharampal MD, Presenter: Nothing to Disclose

Alexia Rossi MD, Abstract Co-Author: Nothing to Disclose

Annick C. Weustink MD, PhD, Abstract Co-Author: Nothing to Disclose

Lisan Anna Neefjes MD, Abstract Co-Author: Nothing to Disclose

Koen Nieman MD, PhD, Abstract Co-Author: Nothing to Disclose

Nico R. Mollet MD, Abstract Co-Author: Nothing to Disclose

Eric H. Boersma PhD, Abstract Co-Author: Nothing to Disclose

Gabriel P. Krestin MD, PhD, Abstract Co-Author: Consultant, General Electric Company Research grant, General Electric Company Research grant, Bayer AG Research grant, Siemens AG

Pim J. De Feyter MD, PhD, Abstract Co-Author: Nothing to Disclose

The aim of this study was to determine the diagnostic accuracy of CT coronary angiography (CTCA) in women with low, intermediate and high risk of having significant coronary artery disease (CAD).

A total of 275 symptomatic women without prior history of coronary revascularization who underwent both CTCA and invasive coronary angiography between 2004 and 2009 were retrospectively included. The pre-test probability for significant CAD was estimated using the Duke Clinical Score and were grouped in low (≤20% probability), intermediate (21% to 80% probability), and high risk (≥81% probability). The diagnostic accuracy of CTCA to detect significant CAD (≥50% lumen diameter narrowing) was assessed in the different risk groups on a per patient level.

Two-hundred-and-seventy-five women were stratified, of which 50 in low risk group, 183 in intermediate risk group and 42 in high risk group. The estimated pre-test probability in the low, intermediate and high risk groups were 12%, 49% and 89%, resp. The prevalence of at least one obstructive lesion on patient level in the low, intermediate and high risk groups were 38%, 66%, and 83%, resp. The median calcium score in the low, intermediate and high risk group was, 4 (25th and 75th percentile: 0–174), 154 (20–482) and 416 (216–891) resp. In the low risk group the sensitivity, specificity, PPV and NPV was 100% (95 % CI: 83–100%), 74% (57–86%), 70% (52–84%) and 100% (85–100%). In the intermediate risk group the sensitivity, specificity, PPV and NPV was 98% (94–100%), 78% (66–86%), 89% (83–94%) and 96% (87–99%). In the high risk group the sensitivity, specificity, PPV and NPV was 100% (90–100%), 57% (25–84%), 92% (81–97%) and 100% (51–100%).

The prevalence of CAD in women is underestimated in low and intermediate risk groups. CTCA can accurately rule out significant CAD in women with all risk groups. The post-test probability for detecting significant CAD is not depended on the pre-test probability of disease and is similar in the various risk groups.

Women with significant coronary artery disease are generally under-diagnosed. CT coronary angiography has the potential to improve the detection of significant CAD in women.

Dharampal, A, Rossi, A, Weustink, A, Neefjes, L, Nieman, K, Mollet, N, Boersma, E, Krestin, G, De Feyter, P, Diagnostic Accuracy of Computed Tomography Coronary Angiography (64-slice) in Women with Low, Intermediate, and High Risk for Coronary Artery Disease.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11012790.html