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Noninvasive Technologies for Diagnosing Coronary Artery Disease in Women

Slide: 17 of 23

Noninvasive Technologies for Diagnosing Coronary Artery Disease in Women: Other Findings

Within a given diagnostic modality, the summary sensitivities and specificities were similar for both types of populations evaluated in the studies (studies that included patients with unknown coronary artery disease [CAD] and studies that included a mixed population of patients with known and unknown CAD).

The diagnostic accuracy of the available noninvasive technologies (NITs) appears to be consistent over time, except for the sensitivity of cardiac magnetic resonance imaging (CMR), which appears to be increasing over time; however, the large confidence intervals for the accuracy of CMR reflect the underlying uncertainty of this measure.

Studies evaluating CMR and coronary CTA in women are limited (low level of evidence) with wider confidence intervals and would benefit from additional investigations.

There was limited or insufficient evidence on how clinical and demographic factors influence the accuracy of NITs for diagnosing CAD in women. From 11 studies identified for inclusion in the report, the assessed predictors included: (1) postmenopausal women ages 55 to 64, (2) race/ethnicity, (3) heart size, (4) pretest probability, and (5) use of beta-blocker medications. Despite widespread acknowledgment that patient variables can affect the accuracy of NITs, no studies examining the influence of age alone, functional status, or body size on diagnostic accuracy in women were identified. There was significant variability in diagnostic accuracy and significant heterogeneity in the types of the predictors reported in the literature on NITs.

There were insufficient data to demonstrate that the use of specific NITs (when compared with coronary angiography) routinely provided incremental risk stratification, prognostic information, or other meaningful information to improve decisionmaking and patient outcomes. Most findings reported in the literature would require significant confirmation and replication in larger studies with women.