TY - JOUR
T1 - Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Women Versus Men
T2 - Long-Term Outcomes From the CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter) Registry
AU - Xie, Joe X.
AU - Eshtehardi, Parham
AU - Varghese, Tina
AU - Goyal, Abhinav
AU - Mehta, Puja K.
AU - Kang, William
AU - Leipsic, Jonathon
AU - Ó Hartaigh, Bríain
AU - Bairey Merz, C. Noel
AU - Berman, Daniel S.
AU - Gransar, Heidi
AU - Budoff, Matthew J.
AU - Achenbach, Stephan
AU - Callister, Tracy Q.
AU - Marques, Hugo
AU - Rubinshtein, Ronen
AU - Al-Mallah, Mouaz H.
AU - Andreini, Daniele
AU - Pontone, Gianluca
AU - Cademartiri, Filippo
AU - Maffei, Erica
AU - Chinnaiyan, Kavitha
AU - Raff, Gilbert
AU - Hadamitzky, Martin
AU - Hausleiter, Joerg
AU - Feuchtner, Gudrun
AU - Kaufmann, Philipp A.
AU - Villines, Todd C.
AU - Chow, Benjamin J.W.
AU - Min, James K.
AU - Shaw, Leslee J.
N1 - Publisher Copyright:
© 2017 American Heart Association, Inc.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - 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.
AB - 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.
KW - coronary computed tomographic angiography
KW - incidence
KW - left main
KW - nonobstructive coronary artery disease
KW - sex disparities in coronary heart disease
UR - https://www.scopus.com/pages/publications/85028025345
U2 - 10.1161/CIRCIMAGING.117.006246
DO - 10.1161/CIRCIMAGING.117.006246
M3 - Article
C2 - 28790123
AN - SCOPUS:85028025345
SN - 1941-9651
VL - 10
JO - Circulation: Cardiovascular Imaging
JF - Circulation: Cardiovascular Imaging
IS - 8
ER -