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Published on: September 22, 2023
Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction
Michelle C Williams1, Jacek Kwiecinski2, Mhairi Doris3
1BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, United Kingdom.
Insights
Women with chest pain have less coronary plaque than men, but low-attenuation plaque predicts myocardial infarction (MI) similarly in both sexes. This finding is crucial for understanding sex differences in coronary artery disease prognosis.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Coronary artery disease (CAD) exhibits significant sex-based disparities in risk factors, symptoms, prevalence, and prognosis.
- Women with chest pain often present differently than men, necessitating sex-specific diagnostic and prognostic approaches.
Purpose of the Study:
- To determine if coronary computed tomography angiography (CCTA) assessments of coronary plaque can explain prognostic differences between men and women with chest pain.
- To investigate sex differences in coronary artery stenosis, plaque characteristics, and plaque burden using CCTA.
Main Methods:
- A multicenter randomized controlled trial involving 1,769 participants (43% female) who underwent CCTA.
- Exploration of sex differences in plaque characteristics (positive remodeling, low-attenuation plaque, spotty calcification, napkin ring sign) and quantitative plaque burden (total, calcified, noncalcified, low-attenuation).
Main Results:
- Women had less overall atherosclerotic plaque, including lower total, calcified, noncalcified, and low-attenuation plaque burdens compared to men (p < 0.001 for all).
- Despite less plaque, women had a lower incidence of myocardial infarction (MI) (1.4% vs. 3%, p < 0.001).
- Low-attenuation plaque burden independently predicted MI in both sexes (HR: 1.60; 95% CI: 1.10-2.34; p = 0.015).
Conclusions:
- Women with chest pain have less coronary atherosclerotic plaque but a lower risk of subsequent MI compared to men.
- Quantitative assessment of low-attenuation plaque is a significant predictor of subsequent MI, equally in women and men.
- CCTA-derived plaque characteristics, particularly low-attenuation plaque, offer valuable prognostic information irrespective of sex.
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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