Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk Of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry

Overview

Journal JACC Cardiovasc Imaging

Publisher Elsevier

Specialties Cardiology & Vascular Diseases
Radiology

Date 2016 Apr 9

PMID 27056154

Citations 45

Authors

Joshua Schulman-Marcus

Briain O Hartaigh

Heidi Gransar

Fay Lin

Valentina Valenti

Iksung Cho

Daniel Berman

Tracy Callister

Augustin DeLago

Martin Hadamitzky

Joerg Hausleiter

Mouaz Al-Mallah

Matthew Budoff

Philipp Kaufmann

Stephan Achenbach

Gilbert Raff

Kavitha Chinnaiyan

Filippo Cademartiri

Erica Maffei

Todd Villines

Yong-Jin Kim

Jonathon Leipsic

Gudrun Feuchtner

Ronen Rubinshtein

Gianluca Pontone

Daniele Andreini

Hugo Marques

Leslee Shaw

James K Min

Affiliations

Soon will be listed here.

Abstract

Objectives: The purpose of this study was to examine sex-specific associations, if any, between per-vessel coronary artery disease (CAD) extent and the risk of major adverse cardiovascular events (MACE) over a 5-year study duration.

Background: The presence and extent of CAD diagnosed by coronary computed tomography angiography (CTA) is associated with increased short-term mortality and MACE. Nevertheless, some uncertainty remains regarding the influence of sex on these findings.

Methods: 5,632 patients (mean age 60.2 ± 11.8 years, 36.5% women) from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry were followed for 5 years. Obstructive CAD was defined as ≥50% luminal stenosis in a coronary vessel. Using Cox proportional hazards models, we calculated the hazard ratio (HR) for incident MACE among women and men, defined as death or myocardial infarction.

Results: Obstructive CAD was more prevalent in men (42% vs. 26%; p < 0.001), whereas women were more likely to have normal coronary arteries (43% vs. 27%; p < 0.001). There were a total of 798 incident MACE events. After adjustment, there was a strong association between increased MACE risk and nonobstructive CAD (HR: 2.16 for women, 2.56 for men; p < 0.001 for both), obstructive 1-vessel CAD (HR: 3.69 and 2.66; p < 0.001), 2-vessel CAD (HR: 3.92 and 3.55; p < 0.001), and 3-vessel/left main CAD (HR: 5.94 and 4.44; p < 0.001). Further exploratory analyses of atherosclerotic burden did not identify sex-specific patterns predictive of MACE.

Conclusions: In a large prospective coronary CTA cohort followed long-term, we did not observe an interaction of sex for the association between MACE risk and increased per-vessel extent of obstructive CAD. These findings highlight the persistent prognostic significance of anatomic CAD subsets as detected by coronary CTA for the risk of MACE in both women and men.

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