Abstract
Evolving evidence suggests unique sex-specific mechanisms underlying coronary artery disease (CAD). However, it remains unknown if certain coronary atherosclerotic features confer a higher risk for ischemia in women versus men.
To determine the association between coronary atherosclerotic features on coronary computed tomography angiography (CCTA) and ischemia by invasive fractional flow reserve (FFR) in women versus men.
Secondary analysis of the CREDENCE trial, including patients referred for nonemergent invasive coronary angiography (ICA). All patients underwent CCTA with semi-automatic quantification of coronary atherosclerosis, as well as ICA with FFR interrogation of all major epicardial arteries ≥2 mm. Generalized estimating equations were calculated to assess the association between coronary atherosclerotic features and invasive vessel-specific ischemia (FFR ≤0.80). Sex interactions were tested, adjusted for age.
From 612 patients (mean age 64±10 years, 30% women) with 1,686 analyzed vessels, a total of 436 (26%) vessels were ischemic. Women were significantly older than men (p<0.001), but with similar distribution of risk factors and medication usage (p≥0.09). In both women and men, all general and compositional features of coronary atherosclerosis were significantly associated with ischemia. However, tests for interaction (Figure 1) revealed higher relative odds for ischemia among women as compared to men for total percent atheroma volume ([PAV], p=0.006), the number of lesions with high-risk plaque (p=0.027), the number of lesions with >30% stenosis (p=0.030), noncalcified PAV <130 HU and <350 HU (p≤0.003), and calcified PAV (p=0.007).
Our results support a prominent influence of coronary atherosclerotic features that uniquely impact ischemic risk among women more so than men. These data support the role of CCTA for providing valuable information to guide management of symptomatic women.
Figure 1. Ischemic risk in women vs. men
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health - National Heart, Lung, and Blood Institute
