Michelle C Williams1, Jacek Kwiecinski2, Mhairi Doris3, Priscilla McElhinney4, Michelle S D'Souza3, Sebastien Cadet4, Philip D Adamson3, Alastair J Moss3, Shirjel Alam3, Amanda Hunter3, Anoop S V Shah3, Nicholas L Mills3, Tania Pawade3, Chengjia Wang3, Jonathan R Weir-McCall5, Michael Bonnici-Mallia6, Christopher Murrills6, Giles Roditi7, Edwin J R van Beek8, Leslee J Shaw9, Edward D Nicol10, Daniel S Berman4, Piotr J Slomka4, David E Newby8, Marc R Dweck8, Damini Dey4. 1. BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, United Kingdom. Electronic address: michelle.williams@ed.ac.uk. 2. BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. 3. BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom. 4. Cedars-Sinai Medical Center, Los Angeles, California, USA. 5. University of Cambridge, Cambridge, United Kingdom. 6. Department of Radiology, Ninewells Hospital, Dundee, United Kingdom. 7. Institute of Clinical Sciences, University of Glasgow, United Kingdom. 8. BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, United Kingdom. 9. Weill Cornell Medical College, New York, New York, USA. 10. Royal Brompton and Harefield NHS Foundation Trust Departments of Cardiology and Radiology, London, United Kingdom, and the National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, United Kingdom.
Abstract
OBJECTIVES: This study was designed to investigate whether coronary computed tomography angiography assessments of coronary plaque might explain differences in the prognosis of men and women presenting with chest pain. BACKGROUND: Important sex differences exist in coronary artery disease. Women presenting with chest pain have different risk factors, symptoms, prevalence of coronary artery disease and prognosis compared to men. METHODS: Within a multicenter randomized controlled trial, we explored sex differences in stenosis, adverse plaque characteristics (positive remodeling, low-attenuation plaque, spotty calcification, or napkin ring sign) and quantitative assessment of total, calcified, noncalcified and low-attenuation plaque burden. RESULTS: Of the 1,769 participants who underwent coronary computed tomography angiography, 772 (43%) were female. Women were more likely to have normal coronary arteries and less likely to have adverse plaque characteristics (p < 0.001 for all). They had lower total, calcified, noncalcified, and low-attenuation plaque burdens (p < 0.001 for all) and were less likely to have a low-attenuation plaque burden >4% (41% vs. 59%; p < 0.001). Over a median follow-up of 4.7 years, myocardial infarction (MI) occurred in 11 women (1.4%) and 30 men (3%). In those who had MI, women had similar total, noncalcified, and low-attenuation plaque burdens as men, but men had higher calcified plaque burden. Low-attenuation plaque burden predicted MI (hazard ratio: 1.60; 95% confidence interval: 1.10 to 2.34; p = 0.015), independent of calcium score, obstructive disease, cardiovascular risk score, and sex. CONCLUSIONS: Women presenting with stable chest pain have less atherosclerotic plaque of all subtypes compared to men and a lower risk of subsequent MI. However, quantitative low-attenuation plaque is as strong a predictor of subsequent MI in women as in men. (Scottish Computed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).
OBJECTIVES: This study was designed to investigate whether coronary computed tomography angiography assessments of coronary plaque might explain differences in the prognosis of men and women presenting with chest pain. BACKGROUND: Important sex differences exist in coronary artery disease. Women presenting with chest pain have different risk factors, symptoms, prevalence of coronary artery disease and prognosis compared to men. METHODS: Within a multicenter randomized controlled trial, we explored sex differences in stenosis, adverse plaque characteristics (positive remodeling, low-attenuation plaque, spotty calcification, or napkin ring sign) and quantitative assessment of total, calcified, noncalcified and low-attenuation plaque burden. RESULTS: Of the 1,769 participants who underwent coronary computed tomography angiography, 772 (43%) were female. Women were more likely to have normal coronary arteries and less likely to have adverse plaque characteristics (p < 0.001 for all). They had lower total, calcified, noncalcified, and low-attenuation plaque burdens (p < 0.001 for all) and were less likely to have a low-attenuation plaque burden >4% (41% vs. 59%; p < 0.001). Over a median follow-up of 4.7 years, myocardial infarction (MI) occurred in 11 women (1.4%) and 30 men (3%). In those who had MI, women had similar total, noncalcified, and low-attenuation plaque burdens as men, but men had higher calcified plaque burden. Low-attenuation plaque burden predicted MI (hazard ratio: 1.60; 95% confidence interval: 1.10 to 2.34; p = 0.015), independent of calcium score, obstructive disease, cardiovascular risk score, and sex. CONCLUSIONS: Women presenting with stable chest pain have less atherosclerotic plaque of all subtypes compared to men and a lower risk of subsequent MI. However, quantitative low-attenuation plaque is as strong a predictor of subsequent MI in women as in men. (Scottish Computed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).
Authors: Damini Dey; Victor Y Cheng; Piotr J Slomka; Ryo Nakazato; Amit Ramesh; Swaminatha Gurudevan; Guido Germano; Daniel S Berman Journal: J Cardiovasc Comput Tomogr Date: 2009-10-01
Authors: C Noel Bairey Merz; Leslee J Shaw; Steven E Reis; Vera Bittner; Sheryl F Kelsey; Marian Olson; B Delia Johnson; Carl J Pepine; Sunil Mankad; Barry L Sharaf; William J Rogers; Gerald M Pohost; Amir Lerman; Arshed A Quyyumi; George Sopko Journal: J Am Coll Cardiol Date: 2006-02-07 Impact factor: 24.094
Authors: Faisal Khosa; Atif N Khan; Khurram Nasir; Arash Bedayat; Zehra Malik; Ali F Jon; Ahmad R Cheema; Melvin E Clouse; Francine K Welty Journal: Atherosclerosis Date: 2012-12-13 Impact factor: 5.162
Authors: Edoardo Conte; Aeshita Dwivedi; Saima Mushtaq; Gianluca Pontone; Fay Y Lin; Emma J Hollenberg; Sang-Eun Lee; Jeroen Bax; Filippo Cademartiri; Kavitha Chinnaiyan; Benjamin J W Chow; Ricardo C Cury; Gudrun Feuchtner; Martin Hadamitzky; Yong-Jin Kim; Andrea Baggiano; Jonathon Leipsic; Erica Maffei; Hugo Marques; Fabian Plank; Gilbert L Raff; Alexander R van Rosendael; Todd C Villines; Harald G Weirich; Subhi J Al'Aref; Lohendran Baskaran; Iksung Cho; Ibrahim Danad; Donghee Han; Ran Heo; Ji Hyun Lee; Wijnand J Stuijfzand; Heidi Gransar; Yao Lu; Ji Min Sung; Hyung-Bok Park; Mouaz H Al-Mallah; Pedro de Araújo Gonçalves; Daniel S Berman; Matthew J Budoff; Habib Samady; Leslee J Shaw; Peter H Stone; Renu Virmani; Jagat Narula; James K Min; Hyuk-Jae Chang; Daniele Andreini Journal: Eur Heart J Cardiovasc Imaging Date: 2021-01-01 Impact factor: 6.875
Authors: Stephen J Nicholls; Kathy Wolski; Ilke Sipahi; Paul Schoenhagen; Timothy Crowe; Samir R Kapadia; Stanley L Hazen; E Murat Tuzcu; Steven E Nissen Journal: J Am Coll Cardiol Date: 2007-03-26 Impact factor: 24.094
Authors: Michelle C Williams; Saroj K Golay; Amanda Hunter; Jonathan R Weir-McCall; Lucja Mlynska; Marc R Dweck; Neal G Uren; John H Reid; Steff C Lewis; Colin Berry; Edwin J R van Beek; Giles Roditi; David E Newby; Saeed Mirsadraee Journal: Open Heart Date: 2015-05-19
Authors: Harmony R Reynolds; C Noel Bairey Merz; Colin Berry; Rohit Samuel; Jacqueline Saw; Nathaniel R Smilowitz; Ana Carolina do A H de Souza; Robert Sykes; Viviany R Taqueti; Janet Wei Journal: Circ Res Date: 2022-02-17 Impact factor: 17.367
Authors: Nidaa Mikail; Alexia Rossi; Susan Bengs; Ahmed Haider; Barbara E Stähli; Angela Portmann; Alessio Imperiale; Valerie Treyer; Alexander Meisel; Aju P Pazhenkottil; Michael Messerli; Vera Regitz-Zagrosek; Philipp A Kaufmann; Ronny R Buechel; Cathérine Gebhard Journal: Eur J Nucl Med Mol Imaging Date: 2022-08-17 Impact factor: 10.057
Authors: Pedro Covas; Eison De Guzman; Ian Barrows; Andrew J Bradley; Brian G Choi; Joseph M Krepp; Jannet F Lewis; Richard Katz; Cynthia M Tracy; Robert K Zeman; James P Earls; Andrew D Choi Journal: Front Cardiovasc Med Date: 2022-03-21
Authors: Carlotta Onnis; Christian Cadeddu Dessalvi; Filippo Cademartiri; Giuseppe Muscogiuri; Simone Angius; Francesca Contini; Jasjit S Suri; Sandro Sironi; Rodrigo Salgado; Antonio Esposito; Luca Saba Journal: Front Cardiovasc Med Date: 2022-09-13