Sex differences in mortality in stable patients undergoing vasodilator stress cardiovascular magnetic resonance. Issue 1 (17th May 2021)

• Record Type: Journal Article
• Authors: Miñana, Gema; Núñez, Julio; Monmeneu, Jose V; López-Lereu, Maria P; Gavara, Jose; Marcos-Garcés, Víctor; Ríos-Navarro, Cesar; Pérez, Nerea; de Dios, Elena; Fernández-Cisnal, Agustín; Núñez, Eduardo; Chorro, Francisco J; Sanchis, Juan; Bodi, Vicente
• Is Part Of: Open heart. Volume 8:Issue 1(2021)
• Publication Date: 2021-05-17
• Subjects: MRI -- chest pain -- percutaneous coronary intervention -- coronary artery bypass; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Patients -- Periodicals; 616.12005
• DOI: 10.1136/openhrt-2021-001619
• Languages: English
• ISSNs: 2398-595X

Abstract

Abstract : Objective: We assessed the influence of the ischaemic burden (IB) as derived from vasodilator stress cardiovascular magnetic resonance (CMR) on the risk of death and the effect of revascularisation across sex. Methods: We evaluated 6237 consecutive patients with known or suspected chronic coronary syndrome (CCS). Extensive ischaemia was defined as >5 segments with perfusion deficit. Multivariate Cox proportional hazard regression models were used. Results: A total of 2371 (38.0%) patients were women and 583 (9.3%) underwent CMR-related revascularisation. During a median follow-up of 5.13 years, 687 (11.0%) deaths were reported. We found an adjusted differential effect of CMR-derived IB across sex (p value for interaction=0.039). Women exhibited an adjusted lower risk of death and only equaled men's risk when extensive ischaemia was present. Likewise, CMR-related revascularisation was shown to be differentially associated with the risk of mortality across sex (p value for interaction=0.025). In patients with non-extensive ischaemia, revascularisation was associated with a higher risk of death, with a greater extent in women. At higher IB, revascularisation was associated with a lower risk in men, with more uncertain results in women. Conclusions: CMR-derived IB allows predicting the risk of death and gives insight into the potential effect of revascularisation in men and women with CCS. Compared with men, women with non-extensive ischaemia displayed a lower risk and a similar risk with a higher IB. The impact of CMR-related revascularisation on mortality risk was also significantly different according to IB and sex. Further research will be needed to confirm these hypothesis-generating findings.