Author + information
- Received February 15, 2016
- Revision received February 19, 2016
- Accepted February 22, 2016
- Published online April 1, 2016.
- Joshua Schulman-Marcus, MDa,
- Bríain ó Hartaigh, PhDa,
- Heidi Gransar, MSb,
- Fay Lin, MDa,
- Valentina Valenti, MDa,
- Iksung Cho, MDa,
- Daniel Berman, MDb,
- Tracy Callister, MDc,
- Augustin DeLago, MDd,
- Martin Hadamitzky, MDe,
- Joerg Hausleiter, MDe,
- Mouaz Al-Mallah, MDf,
- Matthew Budoff, MDg,
- Philipp Kaufmann, MDh,
- Stephan Achenbach, MDi,
- Gilbert Raff, MDj,
- Kavitha Chinnaiyan, MDj,
- Filippo Cademartiri, MDk,
- Erica Maffei, MDk,
- Todd Villines, MDl,
- Yong-Jin Kim, MDm,
- Jonathon Leipsic, MDn,
- Gudrun Feuchtner, MDo,
- Ronen Rubinshtein, MDp,
- Gianluca Pontone, MDq,
- Daniele Andreini, MDq,
- Hugo Marques, MDr,
- Leslee Shaw, MDs and
- James K. Min, MDa,∗ ()
- aDalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
- bDepartment of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
- cTennessee Heart and Vascular Institute, Hendersonville, Tennessee
- dCapital Cardiology Associates, Albany, New York
- eDivision of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
- fResearch Center, King Abdul Aziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia
- gDepartment of Medicine, Harbor UCLA Medical Center, Los Angeles, California
- hUniversity Hospital, Zurich, Switzerland
- iDepartment of Medicine, University of Erlangen, Erlangen, Germany
- jWilliam Beaumont Hospital, Royal Oaks, Michigan
- kCardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy
- lDepartment of Medicine, Walter Reed Medical Center, Washington, DC
- mSeoul National University Hospital, Seoul, South Korea
- nDepartment of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- oDepartment of Radiology, Medical University of Innsbruck, Innsbruck, Austria
- pDepartment of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- qDepartment of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- rDepartment of Surgery, Curry Cabral Hospital, Lisbon, Portugal
- sDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia
- ↵∗Reprint requests and correspondence:
Dr. James K. Min, Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and the New York-Presbyterian Hospital, 413 East 69th Street, Suite 108, New York, New York 10021.
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.
Research reported in this publication was supported by the Heart Lung and Blood Institute of the National institutes of Health under award number R01 HL115150, and funded, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Min has received the following grants, NIH/NIHLBI R01HL111141, NIH/NIHLBI R01HL115150, NIH/NIHLBI R01HL118019, NIH/NIHLBI, U01HL105907, NPRP09-370-3-089. Dr. Min has served as a consultant with HeartFlow; has served on the scientific advisory board of Arineta; has partial ownership in MDDX and Autoplaq; and has received research support from GE Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Schulman-Marcus and ó Hartaigh contributed equally to this work. John Mahmarian, MD, served as Guest Editor for this article.
- Received February 15, 2016.
- Revision received February 19, 2016.
- Accepted February 22, 2016.
- American College of Cardiology Foundation