Journal of Cardiovascular Computed Tomography
Research paperSex differences in coronary atherosclerosis progression and major adverse cardiac events in patients with suspected coronary artery disease
Introduction
Sex differences regarding the prognosis of coronary artery disease (CAD) are well documented,1, 2 and women both with symptoms and with nonobstructive CAD were found more likely to experience major adverse cardiac events (MACE).3 The occurrence of MACE may be associated with the progression of coronary atherosclerosis.4 Intravascular ultrasound and optical coherence tomography can be used to evaluate coronary atherosclerosis progression, but both are invasive, costly and not free from complications. Coronary CT angiography (coronary CTA) is a high-resolution cardiovascular imaging technology that permits the evaluation of luminal stenosis, coronary plaque amount and distribution, as well as plaque progression. Previous studies have demonstrated that plaque progression detected by serial coronary CTA was an independent predictor of acute coronary syndromes.5 However, sex differences in coronary atherosclerosis progression and their association with cardiac events in patients with suspected CAD are still unclear. In our study, we investigating sex differences in coronary atherosclerosis progression as determined by coronary CTA and we analyzed the association between the atherosclerosis progression and MACE stratified by sex.
Section snippets
Patients
The study was approved by the local institutional review board, and the requirement to obtain informed consent was waived. We retrospectively enrolled 1046 patients with suspected CAD who underwent serial coronary CTA because of new or worsening symptoms or because follow-up coronary CTA had been recommended by attending physicians from September 2009 to January 2015. Exclusion criteria included the following: 1) patients who underwent coronary revascularization (percutaneous coronary
Patient demographics
Of the 1046 patients, 953 (91.1%) patients were followed up and 53 (8.9%) were lost to followe up. Of the follow up patients, 608 (63.8%) were men and 345 (36.2%) were women. Women were significantly older than men (mean 57.5 ± 8.6 vs. 51.9 ± 9.8 years, P < 0.001). Clinical characteristics of patients by sex are presented in Table 1. Men had a significantly higher BMI and higher proportion of smoking and history of CAD compared with women (26.3 ± 3.0 vs. 25.1 ± 3.5 kg/m2, 18.8% vs. 4.3%, and
Discussion
Our study demonstrated that sex disparities exist in coronary atherosclerosis progression and that men display significantly greater progression compared with women. Coronary atherosclerosis progression as determined by coronary CTA was significantly associated with the incidence of MACE in both men and women. Statistically significant differences for the risk of MACE were not found between men and women in this study. These findings illustrate that coronary CTA features may be incremental to
Funding
This work had been supported by the key special Grant of Chinese Government (2016YFC1300400 and 2007BAI05B02), and National Natural Science Foundation of China (81371548, 81571672 and 81171343) and a Taishan Scholar Projection.
Conflict of interest
The authors have no conflicts of interest to disclose.
Disclosures
None.
Acknowledgments
None.
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