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Sex-based prognostic implications of nonobstructive coronary artery disease: results from the international

Jonathon Leipsic1, Carolyn M Taylor, Heidi Gransar

  • 1From the Department of Radiology and Medicine, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6S 1Y6 (J.L.); Department of Radiology and Medicine, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6S 1Y6 (J.L., C.M.T., A.A., A.T., K.H.); Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, Calif (H.G., D.S.B.); Department of Medicine, Emory University School of Medicine, Atlanta, Ga (L.J.S.); Division of Cardiology, Technische Universität München, Munichs, Germany (J.H.); Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); Department of Medicine, King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia (M.A.M.); Department of Medicine, Harbor UCLA Medical Center, Los Angeles, Calif (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C.); Tennessee Heart and Vascular Institute, Hendersonville, Tenn (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea (H.J.C.); Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ont, Canada (B.J.W.C.); Baptist Hospital of Miami and Baptist Cardiac and Vascular Institute, Miami, Fla (R.C.C.); Capital Cardiology Associates, Albany, NY (A.J.D.); Department of Public Health and Medicine, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY (A.L.D., F.Y.L.); Department of Radiology II, Innsbruck Medical University, Innsbruck, Austria (G.M.F.); Department of Radiology and Nuclear Medicine, German Heart Center, Munich, Germany (M.H.); Department of Cardiac Imaging, University Hospital, Zurich, Switzerland (P.A.K.); Department of Radiology, William Beaumont Hospital, Royal Oak, Mich (K.M.C., G.L.R.); Department of Radiology, Giovanni XXIII Hospital, Monastier di Treviso, Italy (E.M.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Weill Cornell Medical Coll

Radiology
|July 17, 2014
PubMed

Insights

Women and men with nonobstructive coronary artery disease (CAD) have similar outcomes. This study found comparable rates of major adverse cardiovascular events, including death and myocardial infarction, between sexes after matching for risk factors and disease extent.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Epidemiology

Background:

  • Nonobstructive coronary artery disease (CAD) affects a significant patient population.
  • Understanding sex-based differences in clinical outcomes for nonobstructive CAD is crucial for risk stratification.
  • Coronary computed tomographic (CT) angiography is a key imaging modality for diagnosing CAD.

Purpose of the Study:

  • To compare clinical outcomes between women and men with nonobstructive CAD.
  • To assess the association of nonobstructive CAD with major adverse cardiovascular events (MACE) in both sexes.
  • To investigate outcomes in a propensity-matched cohort to control for confounding factors.

Main Methods:

  • A prospective international multicenter cohort study included 27,125 patients undergoing coronary CT angiography.
  • A propensity-matched cohort of 11,462 subjects (men and women) was created based on age, CAD risk factors, angina typicality, and CAD extent.
  • Multivariable Cox proportional hazards models were used to estimate the risk of MACE (death and myocardial infarction).

Main Results:

  • Over a mean follow-up of 2.3 years, the overall annual MACE rate was 0.6%.
  • After propensity matching, women and men exhibited identical annualized rates for myocardial infarction (0.2%), death (0.5%), and MACE (0.6%).
  • Nonobstructive CAD was associated with similarly increased MACE in both women (HR: 1.96) and men (HR: 1.77).

Conclusions:

  • When matched for key clinical variables, women and men with nonobstructive CAD experience comparable rates of mortality and myocardial infarction.
  • These findings suggest that sex is not an independent predictor of adverse cardiovascular events in patients with nonobstructive CAD after accounting for other factors.
  • The study underscores the importance of considering nonobstructive CAD as a significant risk factor for cardiovascular events in both men and women.
Abstract

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