Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Women Versus Men: Long-Term Outcomes From the CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes. (August 2017)

• Record Type: Journal Article
• Authors: Xie, Joe X.; Eshtehardi, Parham; Varghese, Tina; Goyal, Abhinav; Mehta, Puja K.; Kang, William; Leipsic, Jonathon; ó Hartaigh, Bríain; Bairey Merz, C. Noel; Berman, Daniel S.; Gransar, Heidi; Budoff, Matthew J.; Achenbach, Stephan; Callister, Tracy Q.; Marques, Hugo; Rubinshtein, Ronen; Al-Mallah, Mouaz H.; Andreini, Daniele; Pontone, Gianluca; Cademartiri, Filippo; Maffei, Erica; Chinnaiyan, Kavitha; Raff, Gilbert; Hadamitzky, Martin; Hausleiter, Joerg; Feuchtner, Gudrun; Kaufmann, Philipp A.; Villines, Todd C.; Chow, Benjamin J.W.; Min, James K.; Shaw, Leslee J.;
• Is Part Of: Circulation. Volume 10:Number 8(2017)
• Publication Date: 2017-08
• Subjects: coronary computed tomographic angiography -- incidence -- left main -- nonobstructive coronary artery disease -- sex disparities in coronary heart disease; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.1075405
• DOI: 10.1161/CIRCIMAGING.117.006246
• Languages: English
• ISSNs: 1941-9651

Abstract

Abstract : Background—: Patients with obstructive (≥50% stenosis) left main (LM) coronary artery disease (CAD) are at high risk for adverse events; prior studies have also documented worse outcomes among women than men with severe multivessel/LM CAD. However, the prognostic significance of nonobstructive (1%–49% stenosis) LM CAD, including sex-specific differences, has not been previously examined. Methods and Results—: In the long-term CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter) registry, patients underwent elective coronary computed tomographic angiography for suspected CAD and were followed for 5 years. After excluding those with obstructive LM CAD, 5166 patients were categorized as having normal LM or nonobstructive LM (18% of cohort). Cumulative 5-year incidence of death, myocardial infarction, or revascularization was higher among patients with nonobstructive LM than normal LM in both women and men: women (34.3% versus 15.4%; P <0.0001); men (24.6% versus 18.2%; P <0.0001). A significant interaction existed between sex and LM status for the composite outcome ( P =0.001). In multivariable Cox regression, the presence of nonobstructive LM plaque increased the risk for the composite outcome in women (adjusted hazard ratio, 1.48; P =0.005) but not in men (adjusted hazard ratio, 0.98, P =0.806). In subgroup analysis, women with nonobstructive LM CAD had a nearly 80% higher risk for events than men with nonobstructive LM CAD (adjusted hazard ratio, 1.78; P =0.017); sex-specific interactions were not observed across other patterns (eg, location or extent) of nonobstructive plaque. Conclusion—: Nonobstructive LM CAD was frequently detected on coronary computed tomographic angiography and strongly associated with adverse events among women. Recognizing the sex-specific prognostic significance of nonobstructive LM plaque may augment risk stratification efforts. Abstract : Supplemental Digital Content is available in the text.