Table 2.

Large-scale CTCA trials performed with key sex differences highlighted.

Study and year	Study groups	Key inclusion criteria	Number of participants (% female)	Primary outcome and results	Key sex differences
SCOTHEART 2015 [28]	CTCA + standard care vs standard care	Referred to hospital by primary-care physician with suspected stable angina due to coronary artery disease	4146 (43.9)	Diagnosis reclassified more often in the CTCA group	CTCA resulted in more women being reclassified as not having coronary artery disease
		Age 18–75 years old		23% vs 1%; p 0.001	Absolute risk difference 5.7 (2.7–8.7); p 0.001 [34]
PROMISE 2016 [27]	CTCA vs functional testing	Symptomatic outpatients without coronary artery disease and physician belief that noninvasive/nonurgent imaging required for suspected coronary artery disease	10,003 (52.7)	Composite of death from any cause, myocardial infarction or hospitalization for unstable angina occurred in 3.3% of CTCA vs 3.0% of functional testing	Women more likely to be sent for imaging stress tests than non-imaging tests
		Age 45–54 male, 50–64 female		HR 1.04 (95% CI 0.83–1.29); p = 0.075	OR 1.21 (1.01–1.44); p = 0.043 [24]
		$\ge$1 cardiac risk factor
CRESCENT 2016 [35]	CTCA vs functional testing	Stable chest pain or angina equivalent potentially caused by coronary artery disease	350 (55.3)	Fewer participants had chest pain at 1 year follow-up in the CTCA group	No sex interaction observed for the primary outcome of angina at 1 year or quality of life (all p $\ge$ 0.097)
		$\ge$18 years old		19% vs 25%; p = 0.012	CTCA decreased diagnosis time in women to a greater extent than men (p = 0.012) [32]
				No differences in quality of life between groups (p = 0.759)
CAD-Man 2016 [36]	CTCA vs coronary angiography	Patients presenting with atypical angina pectoris with suspected coronary artery disease and coronary intervention planned	329 (50.4)	No difference in major procedure complications	None reported
		Age $\ge$30 years old		0.6% CTCA vs 0% coronary angiography (p = 1.00)
COME-CCT 2019 [33] (Prospectively designed meta-analysis)	CTCA vs coronary angiography	Patients who have undergone both CTCA and coronary angiography indicated due to stable chest pain	5332 (34.9)	At a pre-test probability of 7%, positive predictive value of CTCA was 50.9% (43.3%–57.7%), negative predictive value 97.8% (96.4%–98.7%).	Diagnostic performance of CTCA was slightly lower in women than in men
		Coronary artery disease with diameter stenosis of $\ge$50%		At pre-test probability of 67%, positive predictive value 82.7% (78.3%–86.2%), negative predictive value 85.0% (80.2%–88.9%)	Area under the curve 0.874 (0.858–0.890) vs 0.907 (0.897–0.916); p 0.001
DISCHARGE 2022 [37]	CTCA vs coronary angiography	Referred for invasive coronary angiogram with stable angina and intermediate likelihood of obstructive disease	3561 (56.3)	Composite of cardiovascular death, non-fatal myocardial infarction or nonfatal stroke occurred in 2.1% in CTCA vs 3.0% in coronary angiography group	None reported
		Age $\ge$30 years old		HR 0.26 (0.13–0.55); p = 0.10

Abbreviations: CI, confidence interval; CTCA, computed tomography coronary angiogram; HR, hazard ratio; OR, odds ratio.