Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography.
J Cardiovasc Comput Tomogr. 2018 Nov - Dec;12(6):451-466. doi: 10.1016/j.jcct.2018.10.019. Epub 2018 Oct 23.
Truong QA1, Rinehart S2, Abbara S3, Achenbach S4, Berman DS5, Bullock-Palmer R6, Carrascosa P7, Chinnaiyan KM8, Dey D5, Ferencik M9, Fuechtner G10, Hecht H11, Jacobs JE12, Lee SE13, Leipsic J14, Lin F15, Meave A16, Pugliese F17, Sierra-Galán LM18, Williams MC19, Villines TC20, Shaw LJ15; SCCT Women's Committee.
This expert consensus statement from the Society of Cardiovascular Computed Tomography (SCCT) provides an evidence synthesis on the use of computed tomography (CT) imaging for diagnosis and risk stratification of coronary artery disease in women. From large patient and population cohorts of asymptomatic women, detection of any coronary artery calcium that identifies females with a 10-year atherosclerotic cardiovascular disease risk of >7.5% may more effectively triage women who may benefit from pharmacologic therapy. In addition to accurate detection of obstructive coronary artery disease (CAD), CT angiography (CTA) identifies nonobstructive atherosclerotic plaque extent and composition which is otherwise not detected by alternative stress testing modalities. Moreover, CTA has superior risk stratification when compared to stress testing in symptomatic women with stable chest pain (or equivalent) symptoms. For the evaluation of symptomatic women both in the emergency department and the outpatient setting, there is abundant evidence from large observational registries and multi-center randomized trials, that CT imaging is an effective procedure. Although radiation doses are far less for CT when compared to nuclear imaging, radiation dose reduction strategies should be applied in all women undergoing CT imaging. Effective and appropriate use of CT imaging can provide the means for improved detection of at-risk women and thereby focus preventive management resulting in long-term risk reduction and improved clinical outcomes.