Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Women Versus Men Long-Term Outcomes From the CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter) Registry

Xie JX, Eshtehardi P, Varghese T, Goyal A, Mehta PK, Kang W, Leipsic J, Hartaigh BO, Merz CNB, Berman DS, Gransar H, Budoff MJ, Achenbach S, Callister TQ, Marques H, Rubinshtein R, Al-Mallah MH, Andreini D, Pontone G, Cademartiri F, Maffei E, Chinnaiyan K, Raff G, Hadamitzky M, Hausleiter J, Feuchtner G, Kaufmann PA, Villines TC, Chow BJW, Min JK, Shaw LJ (2017)

Publication Type: Journal article

Publication year: 2017

Journal

Book Volume: 10

Journal Issue: 8

Abstract

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.

Authors with CRIS profile

Involved external institutions

Emory University United States (USA) (US) University of British Columbia Canada (CA) Cornell University United States (USA) (US) Cedars-Sinai Medical Center United States (USA) (US) Harbor–UCLA Medical Center United States (USA) (US) Tennessee Heart & Vascular United States (USA) (US) Hospital da Luz Portugal (PT) Technion - Israel Institute of Technology Israel (IL) Henry Ford Health System (HFHS) United States (USA) (US) Università degli studi di Milano Italy (IT) Université de Montréal Canada (CA) Beaumont Health System United States (USA) (US) Deutsches Herzzentrum München Germany (DE) Ludwig-Maximilians-Universität (LMU) Germany (DE) Medizinische Universität Innsbruck Austria (AT) Universitätsspital Zürich (USZ) Switzerland (CH) Walter Reed Army Medical Center (WRAMC) United States (USA) (US) University of Ottawa Canada (CA)

How to cite

APA:

Xie, J.X., Eshtehardi, P., Varghese, T., Goyal, A., Mehta, P.K., Kang, W.,... Shaw, L.J. (2017). Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Women Versus Men Long-Term Outcomes From the CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter) Registry. Circulation: Cardiovascular Imaging, 10(8).

MLA:

Xie, Joe X., et al. "Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Women Versus Men Long-Term Outcomes From the CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter) Registry." Circulation: Cardiovascular Imaging 10.8 (2017).

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