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Published on: January 28, 2020

Sex Differences in Coronary Inflammation and Clinical Outcomes Among Patients with Plaque-Positive Non-Obstructive

Bowen Li1,2, Yong Chen3, Xueqiao Yang1,2

  • 1Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan Shandong 250117, China.

European Heart Journal. Quality of Care & Clinical Outcomes
|August 21, 2026
PubMed

Insights

Males with non-obstructive coronary artery disease (CAD) show higher coronary inflammation and worse outcomes than females. The pericoronary fat attenuation index (pFAI) predicts prognosis in these patients.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Sex differences in coronary inflammation in non-obstructive coronary artery disease (CAD) are not well understood.
  • Coronary inflammation assessment using pericoronary fat attenuation index (pFAI) from coronary computed tomography angiography (CCTA) is emerging.
  • This study investigates sex-based disparities in coronary inflammation and their clinical impact in plaque-positive non-obstructive CAD.

Purpose of the Study:

  • To determine sex differences in coronary inflammation using pFAI in patients with non-obstructive CAD.
  • To evaluate the impact of sex-specific coronary inflammation on major adverse cardiovascular events (MACEs).
  • To assess the prognostic value of pFAI in risk stratification for non-obstructive CAD.

Main Methods:

  • Retrospective analysis of 1395 patients with plaque-positive non-obstructive CAD who underwent CCTA.
  • Coronary inflammation quantified by pFAI (HU).
  • Major adverse cardiovascular events (MACEs) tracked over a median of 85 months.

Main Results:

  • Male sex was independently linked to higher coronary inflammation (pFAI > -70.1 HU) and increased MACE risk.
  • Patients with coronary inflammation (pFAI > -70.1 HU) had significantly worse long-term outcomes, consistent across sexes.
  • pFAI independently predicted MACEs in non-obstructive CAD, offering incremental prognostic value beyond clinical and traditional CCTA metrics.

Conclusions:

  • Males with non-obstructive CAD exhibit greater coronary inflammation and poorer outcomes compared to females.
  • pFAI is a significant independent predictor of long-term prognosis in non-obstructive CAD.
  • pFAI enhances risk stratification for patients with plaque-positive non-obstructive CAD.
Abstract

Keywords:
coronary artery diseasecoronary computed tomography angiographynon-obstructive coronary artery diseaseprognosis

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