Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction

Overview

Journal JACC Cardiovasc Imaging

Publisher Elsevier

Specialties Cardiology & Vascular Diseases
Radiology

Date 2021 Apr 18

PMID 33865779

Citations 20

Authors

Michelle C Williams

Jacek Kwiecinski

Mhairi Doris

Priscilla McElhinney

Michelle S DSouza

Sebastien Cadet

Philip D Adamson

Alastair J Moss

Shirjel Alam

Amanda Hunter

Anoop S V Shah

Nicholas L Mills

Tania Pawade

Chengjia Wang

Jonathan R Weir-McCall

Michael Bonnici-Mallia

Christopher Murrills

Giles Roditi

Edwin J R van Beek

Leslee J Shaw

Edward D Nicol

Daniel S Berman

Piotr J Slomka

David E Newby

Marc R Dweck

Damini Dey

Affiliations

Soon will be listed here.

Abstract

Objectives: This study was designed to investigate whether coronary computed tomography angiography assessments of coronary plaque might explain differences in the prognosis of men and women presenting with chest pain.

Background: Important sex differences exist in coronary artery disease. Women presenting with chest pain have different risk factors, symptoms, prevalence of coronary artery disease and prognosis compared to men.

Methods: Within a multicenter randomized controlled trial, we explored sex differences in stenosis, adverse plaque characteristics (positive remodeling, low-attenuation plaque, spotty calcification, or napkin ring sign) and quantitative assessment of total, calcified, noncalcified and low-attenuation plaque burden.

Results: Of the 1,769 participants who underwent coronary computed tomography angiography, 772 (43%) were female. Women were more likely to have normal coronary arteries and less likely to have adverse plaque characteristics (p < 0.001 for all). They had lower total, calcified, noncalcified, and low-attenuation plaque burdens (p < 0.001 for all) and were less likely to have a low-attenuation plaque burden >4% (41% vs. 59%; p < 0.001). Over a median follow-up of 4.7 years, myocardial infarction (MI) occurred in 11 women (1.4%) and 30 men (3%). In those who had MI, women had similar total, noncalcified, and low-attenuation plaque burdens as men, but men had higher calcified plaque burden. Low-attenuation plaque burden predicted MI (hazard ratio: 1.60; 95% confidence interval: 1.10 to 2.34; p = 0.015), independent of calcium score, obstructive disease, cardiovascular risk score, and sex.

Conclusions: Women presenting with stable chest pain have less atherosclerotic plaque of all subtypes compared to men and a lower risk of subsequent MI. However, quantitative low-attenuation plaque is as strong a predictor of subsequent MI in women as in men. (Scottish Computed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).

Citing Articles

Coronary plaque characteristics quantified by artificial intelligence-enabled plaque analysis: Insights from a multi-ethnic asymptomatic US population.

Tomasino G, Park C, Grodecki K, Geers J, Han D, Lin A Am J Prev Cardiol. 2025; 21:100929.

PMID: 39896053 PMC: 11786063. DOI: 10.1016/j.ajpc.2025.100929.

Phenotyping atherosclerotic plaque and perivascular adipose tissue: signalling pathways and clinical biomarkers in atherosclerosis.

Grodecki K, Geers J, Kwiecinski J, Lin A, Slipczuk L, Slomka P Nat Rev Cardiol. 2025; .

PMID: 39743563 DOI: 10.1038/s41569-024-01110-1.

The Role of Cardiac Computed Tomography Angiography in Risk Stratification for Coronary Artery Disease.

van Rosendael S, Shiyovich A, Cardoso R, Souza Freire C, van Rosendael A, Lin F J Soc Cardiovasc Angiogr Interv. 2024; 3(11):102230.

PMID: 39649823 PMC: 11624369. DOI: 10.1016/j.jscai.2024.102230.

Coronary Atherosclerotic Plaque Burden Assessment by Computed Tomography and Its Clinical Implications.

Vatsa N, Faaborg-Andersen C, Dong T, Blaha M, Shaw L, Quintana R Circ Cardiovasc Imaging. 2024; 17(8):e016443.

PMID: 39163370 PMC: 11566462. DOI: 10.1161/CIRCIMAGING.123.016443.

Computed Tomography Angiography Identified High-Risk Coronary Plaques: From Diagnosis to Prognosis and Future Management.

Dimitriadis K, Pyrpyris N, Theofilis P, Mantzouranis E, Beneki E, Kostakis P Diagnostics (Basel). 2024; 14(15).

PMID: 39125547 PMC: 11311283. DOI: 10.3390/diagnostics14151671.

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