Gender Differences in Stress Test and CT Angiography in Patients with Suspected CAD Interview with:
Dr. Neha J. Pagidipati
Duke Clinical Research Institute
Duke University School of Medicine
Durham, North Carolina

Medical Research: What is the background for this study? What are the main findings?

Dr. Pagidipati: Women and men experience coronary artery disease differently, and a great deal of literature has shown that these differences extend to the diagnostic performance of various noninvasive testing modalities. However, little is known about the sex-specific prognostic value of computed tomographic angiography (CTA) and functional stress testing.

We used data from the recent PROMISE trial to address this question. The PROMISE trial enrolled 10,003 patients (53% women) with stable symptoms suggestive of coronary artery disease to a diagnostic strategy of CTA vs stress testing, and found no differences in outcomes overall or by sex. We found that in women, a CTA is less likely to be positive, but when it is positive, it appears to have greater predictive value for a future cardiovascular event (all cause death, myocardial infarction, or unstable angina hospitalization) than stress testing. In men, a stress test is less likely to be positive, and though stress testing trended towards being more predictive of future events, there was no statistically significant difference in the prognostic value of either test type.

Medical Research: What should clinicians and patients take away from your report?

Dr. Pagidipati: This data adds to the growing mountain of evidence that in patients who present in the outpatient setting with symptoms concerning for ischemia, whether the patient is a woman or a man matters, and should likely affect clinical decision-making. Our study suggests that the type of noninvasive test chosen and the interpretation of that test should perhaps also be influenced by the patient’s sex, but without prospective data, a clinical recommendation to test women with CTA cannot be made at this time.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Pagidipati: These results are hypothesis-generating and strongly support the need for prospective data to evaluate whether outpatient women and men should be tested differently for coronary artery disease. While a randomized clinical trial would be ideal, very large numbers and a long follow-up time would be necessary in this population with a relatively low clinical event rate. Instead, registry data such as that collected from electronic health record systems might provide important real-world data on how women and men are being tested in the community, and how these testing strategies affect outcomes

Medical Research: Is there anything else you would like to add?

Dr. Pagidipati: We are greatly appreciative of the PROMISE patients and sites, without whom none of this research would have been possible.


J Am Coll Cardiol. 2016 Mar 29. pii: S0735-1097(16)32402-0. doi: 10.1016/j.jacc.2016.03.523. [Epub ahead of print]

Sex Differences in Functional Stress Test Versus CT Angiography in Symptomatic Patients With Suspected CAD: Insights From PROMISE.

Pagidipati NJ1, Hemal K2, Coles A2, Mark DB2, Dolor RJ3, Pellikka PA4, Hoffmann U5, Litwin SE6, Udelson J7, Daubert MA2, Shah SH3, Martinez B2, Lee KL2, Douglas PS2

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Last Updated on April 15, 2016 by Marie Benz MD FAAD