title: Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry.
abstract: OBJECTIVE
  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.
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY.
authors.forename: Joshua
authors.initials: J
authors.lastname: Schulman-Marcus
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY.
authors.forename: Bríain Ó
authors.initials: BÓ
authors.lastname: Hartaigh
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Gransar
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY.
authors.forename: Fay
authors.initials: F
authors.lastname: Lin
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY.
authors.forename: Valentina
authors.initials: V
authors.lastname: Valenti
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY.
authors.forename: Iksung
authors.initials: I
authors.lastname: Cho
authors.affiliation: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Berman
authors.affiliation: Tennessee Heart and Vascular Institute, Hendersonville, TN.
authors.forename: Tracy
authors.initials: T
authors.lastname: Callister
authors.affiliation: Capital Cardiology Associates, Albany, NY.
authors.forename: Augustin
authors.initials: A
authors.lastname: DeLago
authors.affiliation: Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Hadamitzky
authors.affiliation: Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Hausleiter
authors.affiliation: Research Center, King Abdul Aziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia.
authors.forename: Mouaz
authors.initials: M
authors.lastname: Al-Mallah
authors.affiliation: Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: University Hospital, Zurich, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kaufmann
authors.affiliation: Department of Medicine, University of Erlangen, Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.affiliation: William Beaumont Hospital, Royal Oaks, MI.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Raff
authors.affiliation: William Beaumont Hospital, Royal Oaks, MI.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Chinnaiyan
authors.affiliation: Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.affiliation: Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.affiliation: Department of Medicine, Walter Reed Medical Center, Washington, DC, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Villines
authors.affiliation: Seoul National University Hospital, Seoul, South Korea.
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.affiliation: Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Ronen
authors.initials: R
authors.lastname: Rubinshtein
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.affiliation: Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
authors.forename: Hugo
authors.initials: H
authors.lastname: Marques
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Leslee
authors.initials: L
authors.lastname: Shaw
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
mesh_terms: D000368:Aged; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D009656:North America / Q000453:epidemiology; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D012737:Sex Factors; D013997:Time Factors
keywords: CAD; CT coronary angiography; sex differences