Related Experiment Video
Updated: Jul 7, 2026
A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Differences of plaque burden measures on CCTA in younger men and women
Anum Asif1, C Noel Bairey Merz1, Heidi Gransar2
1Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Insights
Coronary artery disease (CAD) plaque burden on coronary CT angiography (CCTA) predicts mortality. This study found that CCTA measures of plaque burden have a greater prognostic impact in younger women than in younger men.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Coronary artery disease (CAD) extent and severity on coronary CT angiography (CCTA) predict mortality.
- Prognostic significance of CAD plaque burden in younger individuals, particularly women, requires further investigation.
Purpose of the Study:
- To compare the prognostic significance of CAD plaque burden and distribution on CCTA in women and men younger than 60 years.
Main Methods:
- Retrospective analysis of 3813 patients (<60 years) without prior CAD history who underwent CCTA.
- Assessment of CCTA plaque burden included stenosis severity, segment involvement score (SIS), segment stenosis score (SSS), and coronary artery calcium (CAC) scores.
- Primary endpoint was all-cause mortality (ACM); secondary outcome was ACM or non-fatal myocardial infarction (NFMI).
Main Results:
- Higher plaque burden (stenosis, SIS, SSS, CAC) was observed in men compared to women.
- Significant interactions between sex and CCTA measures indicated a higher risk of ACM for women with increasing plaque burden compared to men.
- All plaque burden measures discriminated events better in women than in men, with higher C-statistics in multivariable models for women.
Conclusions:
- Measures of coronary plaque burden identified by CCTA have a greater prognostic impact in younger women compared to younger men.
- These findings highlight sex-specific differences in the prognostic value of CCTA-derived plaque burden.
Importance:
The extent and severity of coronary artery disease (CAD) on coronary CT angiography (CCTA) is predictive of mortality, cardiovascular death, and non-fatal myocardial infarction in both men and women; however, associations of various measures of coronary plaque burden with prognosis in younger women and men has had little study.
Objective:
To compare prognostic significance of CAD plaque burden and distribution on CCTA in women and men <60.
Design:
3813 consecutive patients (age: 49.4 ± 8.1 years, 36 % women) without CAD history who underwent CCTA (2007-2019) with clinical follow-up.
Setting:
Single academic medical center.
Interventions:
None.
Main Outcomes:
CCTA plaque burden was assessed by stenosis severity, segment involvement score (SIS), segment stenosis score (SSS), and coronary artery calcium (CAC) scores. Primary endpoint: all-cause mortality (ACM); secondary outcome: ACM or non-fatal MI (NFMI).
Results:
180 (4.7 %) ACM occurred over a median of 7.4 years, Severity of stenosis, SIS, SSS and extent of CAC were higher in men compared to women (all p < 0.001). In multivariable Cox models, there were significant interactions between sex and all CCTA measures, with women having higher risk than men of ACM with increase of each plaque burden measure compared to men: coronary stenosis (CAD≥50 % HR 6.52 vs 1.86, interaction p = 0.021), SIS (SIS>4 HR 6.94 vs 1.68, interaction p = 0.006), SSS (SSS>6 HR 7.91 vs 1.79, interaction p = 0.006) and CAC (CAC>300 HR 9.62 vs 1.82, interaction p = 0.004). All plaque burden measures discriminated events in women better than men, with C-statistics for multivariable models ranging from 0.729-0.760 in women, compared to 0.674-0.690 in men. Findings were similar for ACM/NFMI.
Conclusions:
Prognostic significance of multiple measures of plaque burden identified by CCTA had greater prognostic impact in younger women, compared with younger men.
Trial Registration:
NA.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Coronary Artery Disease I: Introduction