Lack of Sex Disparity in Cardiovascular Testing After Coronary Computerized Tomographic Angiography

• Published in: Academic emergency medicine Vol. 19; no. 2; pp. 147 - 152
• Main Authors: Ginty, Catherine T., Chang, Anna Marie, Matsuura, Asako C., Decker, Christopher, Le, Jeffrey, Green, Michael, Litt, Harold I., Hollander, Judd E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-02-2012; Wiley Subscription Services, Inc
• Subjects: Acute Coronary Syndrome - diagnostic imaging; Chi-Square Distribution; Coronary Angiography; Emergency medical care; Exercise Test - utilization; Female; Healthcare Disparities; Heart attacks; Humans; Intubation; Male; Medical imaging; Middle Aged; Pennsylvania; Prospective Studies; Risk factors; Sex Factors; Statistics, Nonparametric; Surveys and Questionnaires; Time Factors; Tomography, X-Ray Computed
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/j.1553-2712.2011.01286.x

ACADEMIC EMERGENCY MEDICINE 2012; 19:147–152 © 2012 by the Society for Academic Emergency Medicine
Objectives:  The authors assessed whether there was a sex disparity in testing of patients after coronary computerized tomographic angiography (CTA) was performed for emergency department (ED) patients with potential acute coronary syndromes (ACS). In theory, once coronary anatomy has been determined, any disparity in subsequent workup should not be the result of differences in presentation.
Methods:  This was a prospective cohort study of ED patients who presented with potential ACS and received coronary CTAs at a university hospital. Demographics, history, cardiac risk factors, follow‐up testing, and procedures were recorded. Follow‐up at 30 days was obtained by structured record review and telephone contact. Patients were stratified by sex and coronary CTA results (max stenosis: none, 1% to 24%, 25% to 49%, 50% to 69%, and ≥70%). Main outcome was the relative risk (RR) of a male receiving a stress test or catheterization within 30 days, stratified by categories of percent maximal stenosis.
Results:  A total of 1,144 patients received coronary CTAs (mean ± SD age = 47.8 ± 8.7 years), 55% were female, and 64% were black or African American. Overall, 161 patients received follow‐up testing within 30 days, 113 during their index visit. Men were more likely to receive further testing (RR = 1.51; 95% confidence interval [CI] = 1.14 to 1.99) compared to women. However, when stratified by percentage of stenosis, men were not more likely to receive further testing within 30 days after coronary CTA compared to women (RR = 1.14; 95% CI = 0.68 to 1.91). In multivariable modeling for risk of further testing, stenosis remained significant (adjusted relative risk [aRR] = 1.51; 95% CI = 1.19 to 1.91), while male sex, age, race, and Thrombolysis in Myocardial Infarction (TIMI) risk score were not.
Conclusions:  Male patients with potential ACS who receive a coronary CTA as a part of their ED evaluation were no more likely than female patients to receive further testing within 30 days.