Abstract
Background
Distinct sex-related differences exist in coronary artery plaque burden and distribution.
We aimed to explore sex differences in quantitative plaque burden by coronary CT angiography
(CCTA) in relation to ischemia by invasive fractional flow reserve (FFR).
Methods
This post-hoc analysis of the PACIFIC trial included 581 vessels in 203 patients (mean
age 58.1 ± 8.7 years, 63.5% male) who underwent CCTA and per-vessel invasive FFR.
Quantitative assessment of total, calcified, non-calcified, and low-density non-calcified
plaque burden were performed using semiautomated software. Significant ischemia was
defined as invasive FFR ≤0.8.
Results
The per-vessel frequency of ischemia was higher in men than women (33.5% vs. 7.5%,
p < 0.001). Women had a smaller burden of all plaque subtypes (all p < 0.01).
There was no sex difference on total, calcified, or non-calcified plaque burdens in
vessels with ischemia; only low-density non-calcified plaque burden was significantly
lower in women (beta: -0.183, p = 0.035). The burdens of all plaque subtypes were
independently associated with ischemia in both men and women (For total plaque burden
(5% increase): Men, OR: 1.15, 95%CI: 1.06–1.24, p = 0.001; Women, OR: 1.96, 95%CI:
1.11–3.46, p = 0.02). No significant interaction existed between sex and total plaque
burden for predicting ischemia (interaction p = 0.108). The addition of quantitative
plaque burdens to stenosis severity and adverse plaque characteristics improved the
discrimination of ischemia in both men and women.
Conclusions
In symptomatic patients with suspected CAD, women have a lower CCTA-derived burden
of all plaque subtypes compared to men. Quantitative plaque burden provides independent
and incremental predictive value for ischemia, irrespective of sex.
Graphical abstract
We aimed to explore sex differences in quantitative plaque burden by coronary CT angiography
in relation to ischemia by invasive fractional flow reserve (FFR). Compared to men,
women had lower stenosis severity, fewer adverse plaque characteristics, lower quantitatively
plaque burden and fewer abnormal FFR. In multivariable linear regression analysis,
there was no sex difference on total, calcified, or non-calcified plaque burdens in
vessels with ischemia; only low-density non-calcified plaque burden was significantly
lower in women (beta: −0.183, p = 0.035). The addition of quantitative plaque burden
to stenosis severity and adverse plaque characteristics improved the discrimination
of ischemia irrespective of sex.
Keywords
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Article info
Publication history
Published online: January 18, 2023
Accepted:
December 13,
2022
Received in revised form:
December 12,
2022
Received:
May 13,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
