CaSc Plus CCTA Can Rule Out CAD in Women

September 28, 2015

CCTA, when combined with calcium scoring, can rule out coronary artery disease in women with atypical chest pain.

Combined calcium scoring (CaSc) and coronary computed tomography angiography (CCTA) can exclude approximately half of women who present to the ED with atypical chest pain, according to a study published in the Journal of Women's Health.

Researchers from the Netherlands sought to determine the presence of coronary artery disease (CAD) in women who have atypical chest pain with low or intermediate risk for significant CAD with CaSc combined with CCTA, and to estimate the equivalent radiation dose in women.

A total of 1,033 procedures performed in 1,014 women, which took place from December 2011 to July 2013, were included in the study. The women had been referred for evaluation after undergoing a diagnostic workup for chest pain in the outpatient clinic or after chest pain triage from the emergency department. The mean age was 59; BMI was 26. All women underwent both CaSc and CCTA. The researchers determined absence of CAD as CaSc 0 and absence of noncalcified plaques. Presence of CAD was determined as CaSc greater than 0 and/or presence of noncalcified plaques.

The results showed 520 (51%) women did not have CAD. Among the 494 (49%) of women with CAD, the mean CaSc was 137±229 and 37 (7%) showed only noncalcified plaques. The mean equivalent radiation dose for the cardiac CTs of 1014 women was 2.2±1.6 mSv.

Patient management changed in 536 patients (53%) as a result of the CCTA findings, including modification of medication dosages in 507 patients (50%):

AlterationsNumber of patients
Discontinuation of aspirin127 (13%)
Discontinuation of statins86 (9%)
Discontinuation of beta blockers59 (6%)
Aspirin prescribed61 (6%)
Statins prescribed202 (20%)
Beta blockers prescribed25 (2%)

Referrals for subsequent invasive angiography were given to 45 patients (4%) because of the severity of the plaques detected by CCTA. Four patients (0.54%) went on to undergo myocardial perfusion scintigraphy to determine the extent of ischemia.

“The mean dose length product (DLP) and mean effective radiation dose for the cardiac CTs (including the repeated CCTAs) of 1,014 women were 158±132 mGy/cm and 2.2±1.6 mSv, respectively. The effective dose differed significantly between the different scan modes: 1.4±0.7 mSv for flash mode, 4.2±2.4 mSv for prospective mode and 5.2±2.0 mSv for retrospective mode, p<0.000,” the authors wrote.[[{"type":"media","view_mode":"media_crop","fid":"41750","attributes":{"alt":"Susan G. Kornstein, MD","class":"media-image media-image-right","id":"media_crop_5451203746114","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4437","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Susan G. Kornstein, MD","typeof":"foaf:Image"}}]]

The researchers concluded that the combination of CaSc and CAD can exclude approximately 50% of women who present with atypical chest pain, and delivers a modest radiation dose of 2.2±1.6 mSv.

"This study suggests that CCTA combined with calcium scoring is a useful diagnostic tool for excluding coronary artery disease in women with atypical chest pain, with minimal concerns about radiation exposure," Susan G. Kornstein, MD, editor-in-chief of the Journal of Women’s Health, said in a release. Kornstein is executive director of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA, and President of the Academy of Women's Health.