PROMISE: CTA may better predict events in women than stress testing

CHICAGO — A subanalysis of PROMISE data suggests that women may derive greater prognostic value from CTA than from stress testing, whereas men may derive similar value from both tests, researchers reported at the American College of Cardiology Scientific Session.

“We know that whether a patient is a woman or a man affects the presentation, pathophysiology and outcomes of CAD, and it affects the diagnostic value of CTA and stress testing,” Neha J. Pagidipati, MD, MPH, from Duke Clinical Research Institute, Duke University School of Medicine, said in a presentation. “Yet, there are very little data on the sex-specific prognostic value of CTA and stress testing.”

Pagidipati and colleagues analyzed the relationship between sex and noninvasive testing results and the relationship between sex and a composite of death, MI and unstable angina hospitalization in 8,966 patients from the PROMISE trial. There were 4,500 patients in the CT arm (52% women) and 4,466 patients in the stress testing arm (53% women). Median follow-up was 25 months.

According to results that were simultaneously published in the Journal of the American College of Cardiology, women were less likely to have a positive CTA ( 70% stenosis) than a positive stress test (8% vs. 12%; adjusted OR = 0.67; 95% CI, 0.55-0.82). For women, a positive CTA was more strongly associated with clinical events than a positive stress test (adjusted HR for CTA = 5.86; 95% CI, 3.32-10.35; adjusted HR for stress test = 2.27; 95% CI, 1.21-4.25; adjusted P = .028).

In contrast, men were more likely to have a positive CTA than stress test (16% vs. 14%; adjusted OR = 1.23; 95% CI, 1.04-1.47). For men, a positive CTA was less strongly associated with clinical events compared with a positive stress test, but the difference was not statistically significant (adjusted HR for CTA = 2.8; 95% CI, 1.76-4.45; adjusted HR for stress test = 4.42; 95% CI, 2.77-7.07; adjusted P = .168).

“The three-way interaction between test result, test type and patient sex on outcomes was highly significant, indicating that whether a patient is a woman or a man and whether they receive a CTA or stress testing both influence the likelihood of a clinical event with a positive vs. negative test result,” Pagidipati said during the presentation.

“The relative prognostic values of each [testing] type varies by sex, such that in women, a positive CTA is less likely than a positive stress test, but is more predictive of outcomes than a positive stress test,” Pagidipati said. “In men, a positive CTA is more likely than a positive stress test, and even though there was a trend toward stress testing being more predictive of outcomes, positive results were similarly predictive for both types of tests.” – by Tracey Romero

References :

Pagidipati N, et al. Featured Clinical Research II. Presented at: American College of Cardiology Scientific Session; April 2-4, 2016; Chicago.

Pagidipati N, et al. J Am Coll Cardiol. 2016; doi:10.1016/j.jacc.2016.03.523.

Disclosure: Pagidipati reports no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures.