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Published on: April 13, 2015
Sex Differences in Computed Tomography Coronary Stenosis Severity Versus Flow Impairment and Impact on
Lavinia Gabara1,2, Jonathan Hinton1,2, Mohamed Kira1,2
1Coronary Research Group University Hospital Southampton NHS FT Southampton United Kingdom.
Insights
Women with coronary artery disease show less flow impairment despite similar stenosis severity, leading to different management and lower costs. Sex did not predict major adverse cardiovascular events in this study.
Area of Science:
- Cardiology
- Medical Imaging
- Health Economics
Background:
- Sex-based differences in coronary artery disease (CAD) presentation and outcomes are not fully understood.
- The interplay between coronary atheroma, flow impairment, and clinical impact by sex requires further investigation.
Purpose of the Study:
- To investigate sex differences in coronary stenosis severity and flow impairment using coronary computed tomography angiography (CCTA) and fractional flow reserve derived from computed tomography (FFRCT).
- To assess the association of these findings with revascularization, healthcare costs, and adverse clinical events in patients with stable CAD.
Main Methods:
- Secondary analysis of the FORECAST trial involving 212 patients (32.1% female) with stable CAD.
- Coronary computed tomography angiography (CCTA) and FFRCT were used to assess stenosis severity and flow impairment.
- Outcomes including revascularization, resource usage, and major adverse cardiovascular events were evaluated at 9-month follow-up.
Main Results:
- No significant sex difference in significant coronary artery disease prevalence (38.2% women vs. 51.3% men).
- Female participants exhibited significantly less coronary flow impairment (FFRCT ≤0.8: 47.0% vs. 71.5%).
- Women underwent fewer revascularization procedures and incurred lower healthcare costs compared to men.
Conclusions:
- Significant sex differences exist in the anatomico-functional assessment of coronary artery disease.
- These differences influence clinical management, healthcare costs, and adverse event rates.
- While sex differences impact management and costs, FFRCT and stenosis severity independently predict adverse events.
Background:
The impact of sex-related differences in coronary atheroma and flow impairment severity on clinical events and costs remains unclear.
Methods And Results:
This is a secondary analysis of patients with stable coronary artery disease who underwent both coronary computed tomography angiography and fractional flow reserve derived from computed tomography as part of the FORECAST (Fractional Flow Reserve Derived From Computed Tomography Coronary Angiography in the Assessment and Management of Stable Chest Pain) trial, investigating (1) the relationship between coronary stenosis severity on coronary computed tomography angiography and fractional flow reserve derived from computed tomography FFRCT by sex and (2) the association with revascularization, resource usage, and adverse clinical events. A total of 212 patients (64 female participants [32.1%]) and 1245 vessels were included. There was no significant sex difference in the frequencies of significant coronary artery disease (38.2% of women versus 51.3% of men; P=0.073), but female participants had significantly less coronary flow impairment, according to the presence of at least 1 fractional flow reserve derived from computed tomography≤0.8 (47.0% versus 71.5%; P=0.008). Female subjects underwent fewer revascularization procedures (23.5% versus 42.3%; P=0.014), less coronary artery bypass graft surgery (2.9% versus 13.1%; P=0.025) and were less likely to be on statin treatment (72.0% versus 84.7%; P=0.022) by 9-month follow-up. This resulted in lower overall health care costs for female participants compared with male counterparts (median total cost, £1276 versus £2051; P=0.014). In multivariable Cox analysis the presence of significant coronary artery disease (hazard ratio [HR], 2.91; 95% CI, 1.30-6.51) and having a positive fractional flow reserve derived from computed tomography (HR, 4.11; 95% CI, 1.15-14.69) were independent predictors of major adverse cardiovascular events at 9 months, whereas sex was not statistically significant (p=0.13).
Conclusions:
There are significant sex differences in the anatomico-functional assessment of coronary artery disease leading to differences in clinical management, costs, and adverse events.
