title: Sex-based prognostic implications of nonobstructive coronary artery disease: results from the international multicenter CONFIRM study.
abstract: OBJECTIVE
  To determine the clinical outcomes of women and men with nonobstructive coronary artery disease ( CAD coronary artery disease ) with coronary computed tomographic (CT) angiography data in patients who were similar in terms of CAD coronary artery disease risk factors, angina typicality, and CAD coronary artery disease extent and distribution.
  
  
  METHODS
  Institutional review board approval was obtained for all participating sites, with either informed consent or waiver of informed consent. In a prospective international multicenter cohort study of 27 125 patients undergoing coronary CT angiography at 12 centers, 18 158 patients with no CAD coronary artery disease or nonobstructive (<50% stenosis) CAD coronary artery disease were examined. Men and women were propensity matched for age, CAD coronary artery disease risk factors, angina typicality, and CAD coronary artery disease extent and distribution, which resulted in a final cohort of 11 462 subjects. Nonobstructive CAD coronary artery disease presence and extent were related to incident major adverse cardiovascular events ( MACE major adverse cardiovascular events ), which were inclusive of death and myocardial infarction and were estimated by using multivariable Cox proportional hazards models.
  
  
  RESULTS
  At a mean follow-up ± standard deviation of 2.3 years ± 1.1, MACE major adverse cardiovascular events occurred in 164 patients (0.6% annual event rate). After matching, women and men experienced identical annualized rates of myocardial infarction (0.2% vs 0.2%, P = .72), death (0.5% vs 0.5%, P = .98), and MACE major adverse cardiovascular events (0.6% vs 0.6%, P = .94). In multivariable analysis, nonobstructive CAD coronary artery disease was associated with similarly increased MACE major adverse cardiovascular events for both women (hazard ratio: 1.96 [95% confidence interval { CI confidence interval }: 1.17, 3.28], P = .01) and men (hazard ratio: 1.77 [95% CI confidence interval : 1.07, 2.93], P = .03).
  
  
  CONCLUSIONS
  When matched for age, CAD coronary artery disease risk factors, angina typicality, and nonobstructive CAD coronary artery disease extent, women and men experience comparable rates of incident mortality and myocardial infarction.
authors.affiliation: From the Department of Radiology and Medicine, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6S 1Y6 (J.L.); Department of Radiology and Medicine, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6S 1Y6 (J.L., C.M.T., A.A., A.T., K.H.); Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, Calif (H.G., D.S.B.); Department of Medicine, Emory University School of Medicine, Atlanta, Ga (L.J.S.); Division of Cardiology, Technische Universität München, Munichs, Germany (J.H.); Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); Department of Medicine, King Abdulaziz Cardiac Center, Riyadh, Saudi Arabia (M.A.M.); Department of Medicine, Harbor UCLA Medical Center, Los Angeles, Calif (M.J.B.); Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C.); Tennessee Heart and Vascular Institute, Hendersonville, Tenn (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea (H.J.C.); Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ont, Canada (B.J.W.C.); Baptist Hospital of Miami and Baptist Cardiac and Vascular Institute, Miami, Fla (R.C.C.); Capital Cardiology Associates, Albany, NY (A.J.D.); Department of Public Health and Medicine, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY (A.L.D., F.Y.L.); Department of Radiology II, Innsbruck Medical University, Innsbruck, Austria (G.M.F.); Department of Radiology and Nuclear Medicine, German Heart Center, Munich, Germany (M.H.); Department of Cardiac Imaging, University Hospital, Zurich, Switzerland (P.A.K.); Department of Radiology, William Beaumont Hospital, Royal Oak, Mich (K.M.C., G.L.R.); Department of Radiology, Giovanni XXIII Hospital, Monastier di Treviso, Italy (E.M.); Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.); and Weill Cornell Medical Coll
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mesh_terms: D055424:Cardiac-Gated Imaging Techniques; D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media