Greater percent atheroma volume was associated with a higher risk of cardiovascular death or myocardial infarction in females than males (interaction HR 1.42; 95% CI 1.03-1.95; p=0.032).
Cohort (n=3,645)
Does female sex modify the prognostic value of CCTA-derived percent atheroma volume for predicting cardiovascular events in patients with moderate or severe ischemia and obstructive CAD?
Despite having lower overall atherosclerotic plaque burden, women with moderate to severe ischemia have a higher relative risk of cardiovascular death or MI associated with increasing percent atheroma volume compared to men.
Hazard Ratio: 1.42 (95% CI 1.03–1.95)
p-value: p=0.032
Background: Artificial-intelligence-enabled analysis of atherosclerotic plaque characteristics on coronary computed tomography angiography (CCTA) may improve sex-specific risk prediction of cardiovascular (CV) events. Aims: The aim of this study was to examine sex differences in CCTA-derived atherosclerotic plaque analysis in ISCHEMIA participants, and to identify any interaction between sex and the prognostic value of quantitative atherosclerosis parameters in predicting CV events. Methods: In a post-hoc analysis, atherosclerosis imaging quantitative CT (QCT) was performed on all available CCTA scans. Interaction analysis was performed to understand the impact of female sex on the relationship between QCT variables and the outcomes of CV death or myocardial infarction (MI), all-cause death, and MI alone over a median follow-up of 3.3 years. Results: Of the 3645 participants with CCTA available for analysis, mean age was 64 and 21% were female. Females had lower total, calcified, non-calcified, and low-density non-calcified plaque volume than males (p<0.001 for all, Table). Percent atheroma volume (PAV=total plaque volume /vessel volume x 100%) was associated with CV death or MI in all participants, and the association was stronger in females (univariate HR: 2.37, 95% confidence interval (CI) 1.79, 3.14, p<0.001) than men (HR: 1.70, 95% CI 1.45, 2.00, p<0.001). There was a significant interaction showing accentuated risk of CV death or MI associated with greater PAV among females vs. males (HR for female*PAV: 1.42, 95% CI 1.03, 1.95, p=0.032, Figure), mainly driven by risk for MI. Conclusions: In ISCHEMIA, females presenting with moderate or severe ischemia and obstructive CAD had less atherosclerotic plaque burden of all subtypes and less adverse plaque characteristics identified by CCTA than men. The risk associated with greater atherosclerotic burden (PAV) was higher among female participants than males for the composite outcome of CV death or MI.
Lakshmanan et al. (Tue,) conducted a cohort in Moderate or severe ischemia and obstructive CAD (n=3,645). Percent atheroma volume (PAV) in females vs. Males was evaluated on Cardiovascular death or myocardial infarction (HR 1.42, 95% CI 1.03-1.95, p=0.032). Greater percent atheroma volume was associated with a higher risk of cardiovascular death or myocardial infarction in females than males (interaction HR 1.42; 95% CI 1.03-1.95; p=0.032).