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Title:

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: An International Multicenter) Registry

Document type:
Article
Author(s):
Xie, Joe X.; Eshtehardi, Parham; Varghese, Tina; Goyal, Abhinav; Mehta, Puja K.; Kang, William; Leipsic, Jonathon; Hartaigh, Briain O.; Merz, C. Noel Bairey; 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.;...     »
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.
Journal title abbreviation:
Circ Cardiovasc Imaging
Year:
2017
Journal volume:
10
Journal issue:
8
Language:
eng
Fulltext / DOI:
doi:10.1161/CIRCIMAGING.117.006246
Pubmed ID:
http://view.ncbi.nlm.nih.gov/pubmed/28790123
Print-ISSN:
1941-9651
TUM Institution:
Institut für Radiologie
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