Sex Differences in the Effectiveness of Early Coronary Computed Tomographic Angiography Compared With Standard Emergency Department Evaluation for Acute Chest Pain: The Rule-Out Myocardial Infarction With Computer-Assisted Tomography (ROMICAT)-II Trial

• Published in: Circulation (New York, N.Y.) N.Y.), 2013-06, Vol.127 (25), p.2494-2502
• Main Authors: Truong, Quynh A, Hayden, Douglas, Woodard, Pamela K, Kirby, Ruth, Chou, Eric T, Nagurney, John T, Wiviott, Stephen D, Fleg, Jerome L, Schoenfeld, David A, Udelson, James E, Hoffmann, Udo
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - epidemiology; Acute Disease; Adult; Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular system; Chest Pain - diagnosis; Chest Pain - diagnostic imaging; Chest Pain - epidemiology; Coronary Angiography; Coronary heart disease; Diagnosis, Differential; Diagnostic Tests, Routine; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Emergency Service, Hospital; Female; Heart; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - epidemiology; Myocarditis. Cardiomyopathies; Prevalence; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Severity of Illness Index; Tomography, X-Ray Computed
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.113.001736

BACKGROUND—We evaluate sex-based differences in the effectiveness of early cardiac computed tomographic angiography (CCTA) and standard emergency department (ED) evaluation in patients with acute chest pain. METHODS AND RESULTS—In the Rule-Out Myocardial Infarction With Computer-Assisted Tomography (ROMICAT)-II multicenter, controlled trial, we randomized 1000 patients (47% women) 40 to 74 years of age with symptoms suggestive of acute coronary syndrome to an early CCTA or standard ED evaluation. In this prespecified analysis, women in the CCTA arm had a greater reduction in length of stay, lower hospital admission rates, and lesser increased cumulative radiation dose than men in a comparison of ED strategies (P for interaction ≤0.02). Although women had lower acute coronary syndrome rates than men (3% versus 12%; P