Sex differences in mortality in stable patients undergoing vasodilator stress cardiovascular magnetic resonance

Area of Science:

• Cardiology
• Medical Imaging
• Cardiovascular Disease

Background:

• Chronic coronary syndrome (CCS) affects a significant patient population.
• Assessing ischaemic burden (IB) is crucial for risk stratification.
• Sex-based differences in cardiovascular disease outcomes are increasingly recognized.

Purpose of the Study:

• To evaluate the influence of vasodilator stress cardiovascular magnetic resonance (CMR)-derived ischaemic burden (IB) on mortality risk.
• To investigate the differential effect of revascularisation on mortality across sexes in patients with CCS.
• To explore potential sex-specific interactions between IB and revascularisation outcomes.

Main Methods:

• Retrospective analysis of 6237 consecutive patients with known or suspected CCS.
• Vasodilator stress CMR was used to quantify IB, defining extensive ischaemia as >5 segments with perfusion deficit.
• Multivariate Cox proportional hazard regression models were employed to assess mortality risk and interaction effects.

Main Results:

• Women with CCS exhibited a lower adjusted risk of death compared to men, converging only when extensive ischaemia was present.
• Revascularisation showed a differential association with mortality risk across sexes (p=0.025).
• In non-extensive ischaemia, revascularisation increased mortality risk, particularly in women; at higher IB, it decreased risk in men but showed uncertain results in women.

Conclusions:

• CMR-derived IB effectively predicts mortality risk and informs revascularisation strategies in men and women with CCS.
• Women with non-extensive ischaemia have a lower risk, while risk is similar to men with higher IB.
• The impact of revascularisation on mortality is significantly influenced by IB and sex, warranting further investigation.