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Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry.
JACC Cardiovasc Imaging. 2016 Apr; 9(4):364-372.JC

Abstract

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.

Authors+Show Affiliations

Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY.Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY.Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA.Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY.Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY.Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY.Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA.Tennessee Heart and Vascular Institute, Hendersonville, TN.Capital Cardiology Associates, Albany, NY.Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.Research Center, King Abdul Aziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia.Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA.University Hospital, Zurich, Switzerland.Department of Medicine, University of Erlangen, Erlangen, Germany.William Beaumont Hospital, Royal Oaks, MI.William Beaumont Hospital, Royal Oaks, MI.Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy.Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy.Department of Medicine, Walter Reed Medical Center, Washington, DC, USA.Seoul National University Hospital, Seoul, South Korea.Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada.Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.Division of Cardiology, Emory University School of Medicine, Atlanta, GA.Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27056154

Citation

Schulman-Marcus, Joshua, et al. "Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: the CONFIRM Long-Term Registry." JACC. Cardiovascular Imaging, vol. 9, no. 4, 2016, pp. 364-372.
Schulman-Marcus J, Hartaigh BÓ, Gransar H, et al. Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry. JACC Cardiovasc Imaging. 2016;9(4):364-372.
Schulman-Marcus, J., Hartaigh, B. Ó., Gransar, H., Lin, F., Valenti, V., Cho, I., Berman, D., Callister, T., DeLago, A., Hadamitzky, M., Hausleiter, J., Al-Mallah, M., Budoff, M., Kaufmann, P., Achenbach, S., Raff, G., Chinnaiyan, K., Cademartiri, F., Maffei, E., ... Min, J. K. (2016). Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry. JACC. Cardiovascular Imaging, 9(4), 364-372. https://doi.org/10.1016/j.jcmg.2016.02.010
Schulman-Marcus J, et al. Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: the CONFIRM Long-Term Registry. JACC Cardiovasc Imaging. 2016;9(4):364-372. PubMed PMID: 27056154.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry. AU - Schulman-Marcus,Joshua, AU - Hartaigh,Bríain Ó, AU - Gransar,Heidi, AU - Lin,Fay, AU - Valenti,Valentina, AU - Cho,Iksung, AU - Berman,Daniel, AU - Callister,Tracy, AU - DeLago,Augustin, AU - Hadamitzky,Martin, AU - Hausleiter,Joerg, AU - Al-Mallah,Mouaz, AU - Budoff,Matthew, AU - Kaufmann,Philipp, AU - Achenbach,Stephan, AU - Raff,Gilbert, AU - Chinnaiyan,Kavitha, AU - Cademartiri,Filippo, AU - Maffei,Erica, AU - Villines,Todd, AU - Kim,Yong-Jin, AU - Leipsic,Jonathon, AU - Feuchtner,Gudrun, AU - Rubinshtein,Ronen, AU - Pontone,Gianluca, AU - Andreini,Daniele, AU - Marques,Hugo, AU - Shaw,Leslee, AU - Min,James K, PY - 2016/02/15/received PY - 2016/02/19/revised PY - 2016/02/22/accepted PY - 2016/4/9/entrez PY - 2016/4/9/pubmed PY - 2017/1/18/medline KW - CAD KW - CT coronary angiography KW - sex differences SP - 364 EP - 372 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 9 IS - 4 N2 - 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. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/27056154/Sex_Specific_Associations_Between_Coronary_Artery_Plaque_Extent_and_Risk_of_Major_Adverse_Cardiovascular_Events:_The_CONFIRM_Long_Term_Registry_ DB - PRIME DP - Unbound Medicine ER -