Overview

Cardiovascular disease is the leading cause of mortality for women in the U.S. According to the American Heart Association (AHA), approx. one in three female adults have some form of cardiovascular disease. AHA suggests there is evidence showing that women at risk for coronary artery disease (CAD) are less often referred for the appropriate diagnostic test than are men. Coronary anatomy and pathology have traditionally been defined and identified by coronary angiography, a procedure that is indicated in patients who have chest pain and are at high risk for CAD. For intermediate-risk patients, clinicians have a wide range of noninvasive technologies (NITs) to choose from that can assess functional status (i.e., ischemia or no ischemia) or visualize anatomic abnormalities. Functional modalities include stress electrocardiography (ECG); stress echocardiography (ECHO); and stress radionuclide myocardial perfusion imaging, including single-proton emission computed tomography (SPECT) and positron emission tomography (PET). Anatomic modalities include stress myocardial perfusion and wall-motion cardiac magnetic resonance (CMR) imaging and coronary computed tomography angiography (coronary CTA). The comparative safety and accuracy of these NITs in women was uncertain, although substantial data exists for populations combining men and women, and for mixed populations of known and no known CAD. In 2012, a Comparative Effectiveness Review,

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