Edoardo Conte1, Aeshita Dwivedi2, Saima Mushtaq1, Gianluca Pontone1, Fay Y Lin2, Emma J Hollenberg2, Sang-Eun Lee3,4, Jeroen Bax5, Filippo Cademartiri6, Kavitha Chinnaiyan7, Benjamin J W Chow8, Ricardo C Cury9, Gudrun Feuchtner10, Martin Hadamitzky11, Yong-Jin Kim12, Andrea Baggiano1, Jonathon Leipsic13, Erica Maffei14, Hugo Marques15, Fabian Plank10, Gilbert L Raff7, Alexander R van Rosendael2,5, Todd C Villines16, Harald G Weirich10, Subhi J Al'Aref2, Lohendran Baskaran2,17, Iksung Cho2,18,19, Ibrahim Danad20, Donghee Han18, Ran Heo21, Ji Hyun Lee2,18,21, Wijnand J Stuijfzand2, Heidi Gransar22, Yao Lu2, Ji Min Sung18, Hyung-Bok Park18, Mouaz H Al-Mallah23, Pedro de Araújo Gonçalves24, Daniel S Berman22, Matthew J Budoff25, Habib Samady26, Leslee J Shaw2, Peter H Stone27, Renu Virmani28, Jagat Narula29, James K Min2, Hyuk-Jae Chang18, Daniele Andreini1. 1. Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy. 2. Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA. 3. Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea. 4. Department of Cardiovascular Imaging, Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. 5. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. 6. Department of Cardiovascular Imaging, Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy. 7. Department of Cardiology, William Beaumont Hospital, Royal Oaks, MI, USA. 8. Department of Medicine and Radiology, University of Ottawa, Ottawa, Ontario, Canada. 9. Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA. 10. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. 11. Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany. 12. Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea. 13. Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada. 14. Department of Radiology, Area Vasta 1/ASUR, Marche, Urbino, Italy. 15. UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal. 16. Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA. 17. Department of Cardiovascular Medicine, National Heart Centre, Singapore. 18. Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Seoul, South Korea. 19. Department of Cardiology, Chung-Ang University Hospital, Seoul, South Korea. 20. Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands. 21. Division of Cardiology, Department of Internal Medicine, Hangyang University Medical Center, Seoul, Korea. 22. Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA. 23. Department of Cardiovascular Medicin, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA. 24. Department of Cardiology, UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal. 25. Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA. 26. Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA. 27. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA. 28. Deparment of Pathology, CVPath Institute, Gaithersburg, MD, USA. 29. Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA.
Abstract
AIMS: Although there is increasing evidence supporting coronary atherosclerosis evaluation by coronary computed tomography angiography (CCTA), no data are available on age and sex differences for quantitative plaque features. The aim of this study was to investigate sex and age differences in both qualitative and quantitative atherosclerotic features from CCTA prior to acute coronary syndrome (ACS). METHODS AND RESULTS: Within the ICONIC study, in which 234 patients with subsequent ACS were propensity matched 1:1 with 234 non-event controls, our current subanalysis included only the ACS cases. Both qualitative and quantitative advance plaque analysis by CCTA were performed by a core laboratory. In 129 cases, culprit lesions identified by invasive coronary angiography at the time of ACS were co-registered to baseline CCTA precursor lesions. The study population was then divided into subgroups according to sex and age (<65 vs. ≥ 65 years old) for analysis. Older patients had higher total plaque volume than younger patients. Within specific subtypes of plaque volume, however, only calcified plaque volume was higher in older patients (135.9 ± 163.7 vs. 63.8 ± 94.2 mm3, P < 0.0001, respectively). Although no sex-related differences were recorded for calcified plaque volume, females had lower fibrous and fibrofatty plaque volume than males (Fibrofatty volume 29.6 ± 44.1 vs. 75.3 ± 98.6 mm3, P = 0.0001, respectively). No sex-related differences in the prevalence of qualitative high-risk plaque features were found, even after separate analyses considering age were performed. CONCLUSION: Our data underline the importance of age- and sex-related differences in coronary atherosclerosis presentation, which should be considered during CCTA-based atherosclerosis quantification. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Although there is increasing evidence supporting coronary atherosclerosis evaluation by coronary computed tomography angiography (CCTA), no data are available on age and sex differences for quantitative plaque features. The aim of this study was to investigate sex and age differences in both qualitative and quantitative atherosclerotic features from CCTA prior to acute coronary syndrome (ACS). METHODS AND RESULTS: Within the ICONIC study, in which 234 patients with subsequent ACS were propensity matched 1:1 with 234 non-event controls, our current subanalysis included only the ACS cases. Both qualitative and quantitative advance plaque analysis by CCTA were performed by a core laboratory. In 129 cases, culprit lesions identified by invasive coronary angiography at the time of ACS were co-registered to baseline CCTA precursor lesions. The study population was then divided into subgroups according to sex and age (<65 vs. ≥ 65 years old) for analysis. Older patients had higher total plaque volume than younger patients. Within specific subtypes of plaque volume, however, only calcified plaque volume was higher in older patients (135.9 ± 163.7 vs. 63.8 ± 94.2 mm3, P < 0.0001, respectively). Although no sex-related differences were recorded for calcified plaque volume, females had lower fibrous and fibrofatty plaque volume than males (Fibrofatty volume 29.6 ± 44.1 vs. 75.3 ± 98.6 mm3, P = 0.0001, respectively). No sex-related differences in the prevalence of qualitative high-risk plaque features were found, even after separate analyses considering age were performed. CONCLUSION: Our data underline the importance of age- and sex-related differences in coronary atherosclerosis presentation, which should be considered during CCTA-based atherosclerosis quantification. Published on behalf of the European Society of Cardiology. All rights reserved.
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