Article ; Online: Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction.
2021 Volume 14, Issue 9, Page(s) 1804–1814
Abstract: Objectives: This study was designed to investigate whether coronary computed tomography angiography assessments of coronary plaque might explain differences in the prognosis of men and women presenting with chest pain.: Background: Important sex ... ...
| Abstract | Objectives: This study was designed to investigate whether coronary computed tomography angiography assessments of coronary plaque might explain differences in the prognosis of men and women presenting with chest pain. Background: Important sex differences exist in coronary artery disease. Women presenting with chest pain have different risk factors, symptoms, prevalence of coronary artery disease and prognosis compared to men. Methods: Within a multicenter randomized controlled trial, we explored sex differences in stenosis, adverse plaque characteristics (positive remodeling, low-attenuation plaque, spotty calcification, or napkin ring sign) and quantitative assessment of total, calcified, noncalcified and low-attenuation plaque burden. Results: Of the 1,769 participants who underwent coronary computed tomography angiography, 772 (43%) were female. Women were more likely to have normal coronary arteries and less likely to have adverse plaque characteristics (p < 0.001 for all). They had lower total, calcified, noncalcified, and low-attenuation plaque burdens (p < 0.001 for all) and were less likely to have a low-attenuation plaque burden >4% (41% vs. 59%; p < 0.001). Over a median follow-up of 4.7 years, myocardial infarction (MI) occurred in 11 women (1.4%) and 30 men (3%). In those who had MI, women had similar total, noncalcified, and low-attenuation plaque burdens as men, but men had higher calcified plaque burden. Low-attenuation plaque burden predicted MI (hazard ratio: 1.60; 95% confidence interval: 1.10 to 2.34; p = 0.015), independent of calcium score, obstructive disease, cardiovascular risk score, and sex. Conclusions: Women presenting with stable chest pain have less atherosclerotic plaque of all subtypes compared to men and a lower risk of subsequent MI. However, quantitative low-attenuation plaque is as strong a predictor of subsequent MI in women as in men. (Scottish Computed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590). |
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| MeSH term(s) | Computed Tomography Angiography ; Coronary Angiography ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/epidemiology ; Coronary Vessels/diagnostic imaging ; Female ; Humans ; Male ; Myocardial Infarction/diagnostic imaging ; Myocardial Infarction/epidemiology ; Plaque, Atherosclerotic ; Predictive Value of Tests ; Risk Factors |
| Language | English |
| Publishing date | 2021-04-14 |
| Publishing country | United States |
| Document type | Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 2491503-8 |
| ISSN | 1876-7591 ; 1936-878X |
| ISSN (online) | 1876-7591 |
| ISSN | 1936-878X |
| DOI | 10.1016/j.jcmg.2021.03.004 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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