Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction

JACC-CARDIOVASCULAR IMAGING

卷:14

Article

Williams, Michelle C.^1,2  Kwiecinski, Jacek^1,3  Doris, Mhairi¹  McElhinney, Priscilla⁴  D'Souza, Michelle S.¹  Cadet, Sebastien⁴  Adamson, Philip D.¹  Moss, Alastair J.¹  Alam, Shirjel¹  Hunter, Amanda¹  Shah, Anoop S. V.¹  Mills, Nicholas L.¹  Pawade, Tania¹  Wang, Chengjia¹  Weir-McCall, Jonathan R.⁵  Bonnici-Mallia, Michael⁶  Murrills, Christopher⁶  Roditi, Giles⁷  van Beek, Edwin J. R.^1,2  Shaw, Leslee J.⁸  Nicol, Edward D.^9,10  Berman, Daniel S.⁴  Slomka, Piotr J.⁴  Newby, David E.^1,2  Dweck, Marc R.^1,2  Dey, Damini⁴ 

[1] Univ Edinburgh, BHF Ctr Cardiovasc Sci, Chancellors Bldg,49 Little France Crescent, Edinburgh EH16 SUF, Midlothian, Scotland

[2] Univ Edinburgh, Edinburgh Imaging Facil QMRI, Edinburgh, Midlothian, Scotland

[3] Inst Cardiol, Dept Intervent Cardiol & Angiol, Warsaw, Poland

[4] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA

[5] Univ Cambridge, Cambridge, England

[6] Ninewells Hosp, Dept Radiol, Dundee, Scotland

[7] Univ Glasgow, Inst Clin Sci, Glasgow, Lanark, Scotland

[8] Weill Cornell Med Coll, New York, NY USA

[9] Royal Brompton & Harefield NHS Fdn Trust, Dept Cardiol & Radiol, London, England

[10] Imperial Coll, Natl Heart & Lung Inst, Fac Med, London, England

关键词: computed tomography;    computed tomography coronary angiography;    coronary artery disease;    sex;    quantitative plaque analysis;   

DOI  :  10.1016/j.jcmg.2021.03.004

来源: Elsevier

【 摘 要 】

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. Lowattenuation 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. (C) 2021 by the American College of Cardiology Foundation.

【 授权许可】

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