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

Joe X Xie, Parham Eshtehardi, Tina Varghese, Abhinav Goyal, Puja K Mehta, William Kang, Jonathon Leipsic, Bríain Ó Hartaigh, C Noel Bairey Merz, Daniel S Berman, Heidi Gransar, Matthew J Budoff, Stephan Achenbach, Tracy Q Callister, Hugo Marques, Ronen Rubinshtein, Mouaz H Al-Mallah, Daniele Andreini, Gianluca Pontone, Filippo CademartiriErica Maffei, Kavitha Chinnaiyan, Gilbert Raff, Martin Hadamitzky, Joerg Hausleiter, Gudrun Feuchtner, Philipp A Kaufmann, Todd C Villines, Benjamin J W Chow, James K Min, Leslee J Shaw

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalCirculation: Cardiovascular Imaging
Volume10
Issue number8
DOIs
Publication statusPublished - Aug 2017

Keywords

  • Aged
  • Computed Tomography Angiography
  • Coronary Angiography
  • Coronary Artery Disease
  • Coronary Stenosis
  • Coronary Vessels
  • Disease Progression
  • Female
  • Health Status Disparities
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Myocardial Revascularization
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Sex Factors
  • Time Factors
  • Comparative Study
  • Journal Article
  • Multicenter Study

Fingerprint Dive into the research topics of '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'. Together they form a unique fingerprint.

  • Cite this

    Xie, J. X., Eshtehardi, P., Varghese, T., Goyal, A., Mehta, P. K., Kang, W., Leipsic, J., Ó Hartaigh, B., Bairey Merz, C. N., Berman, D. S., Gransar, H., Budoff, M. J., Achenbach, S., Callister, T. Q., Marques, H., Rubinshtein, R., Al-Mallah, M. H., Andreini, D., Pontone, G., ... Shaw, L. J. (2017). 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. Circulation: Cardiovascular Imaging, 10(8). https://doi.org/10.1161/CIRCIMAGING.117.006246