Sex-Specific Associations between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events the CONFIRM Long-Term Registry

Joshua Schulman-Marcus, Bríain Ó Hartaigh, Heidi Gransar, Fay Lin, Valentina Valenti, Iksung Cho, Daniel Berman, Tracy Callister, Augustin Delago, Martin Hadamitzky, Joerg Hausleiter, Mouaz Al-Mallah, Matthew Budoff, Philipp Kaufmann, Stephan Achenbach, Gilbert Raff, Kavitha Chinnaiyan, Filippo Cademartiri, Erica Maffei, Todd VillinesYong Jin Kim, Jonathon Leipsic, Gudrun Feuchtner, Ronen Rubinshtein, Gianluca Pontone, Daniele Andreini, Hugo Marques, Leslee Shaw, James K. Min

Research output: Contribution to journalArticlepeer-review


Objectives The purpose of this study was to examine sex-specific associations, if any, between per-vessel coronary artery disease (CAD) extent and the risk of major adverse cardiovascular events (MACE) over a 5-year study duration. Background The presence and extent of CAD diagnosed by coronary computed tomography angiography (CTA) is associated with increased short-term mortality and MACE. Nevertheless, some uncertainty remains regarding the influence of sex on these findings. Methods 5,632 patients (mean age 60.2 ± 11.8 years, 36.5% women) from the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry were followed for 5 years. Obstructive CAD was defined as ≥50% luminal stenosis in a coronary vessel. Using Cox proportional hazards models, we calculated the hazard ratio (HR) for incident MACE among women and men, defined as death or myocardial infarction. Results Obstructive CAD was more prevalent in men (42% vs. 26%; p <0.001), whereas women were more likely to have normal coronary arteries (43% vs. 27%; p <0.001). There were a total of 798 incident MACE events. After adjustment, there was a strong association between increased MACE risk and nonobstructive CAD (HR: 2.16 for women, 2.56 for men; p <0.001 for both), obstructive 1-vessel CAD (HR: 3.69 and 2.66; p <0.001), 2-vessel CAD (HR: 3.92 and 3.55; p <0.001), and 3-vessel/left main CAD (HR: 5.94 and 4.44; p <0.001). Further exploratory analyses of atherosclerotic burden did not identify sex-specific patterns predictive of MACE. Conclusions In a large prospective coronary CTA cohort followed long-term, we did not observe an interaction of sex for the association between MACE risk and increased per-vessel extent of obstructive CAD. These findings highlight the persistent prognostic significance of anatomic CAD subsets as detected by coronary CTA for the risk of MACE in both women and men.

Original languageEnglish
Pages (from-to)364-372
Number of pages9
JournalJACC: Cardiovascular Imaging
Issue number4
Publication statusPublished - Apr 1 2016


  • CAD
  • CT coronary angiography
  • sex differences

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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