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.
Circ Cardiovasc Imaging
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%;
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.
Medical Subject Headings
Aged; Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease; Coronary Stenosis; Coronary Vessels; Disease Progression; Female; Health Status Disparities; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Myocardial Revascularization; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Sex Factors; Time Factors
Xie JX, Eshtehardi P, Varghese T, Goyal A, Mehta PK, Kang W, Leipsic J, Ó Hartaigh B, Bairey Merz CN, 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. 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. Circ Cardiovasc Imaging. 2017 Aug;10(8). doi: 10.1161/CIRCIMAGING.117.006246. PubMed PMID: 28790123; PubMed Central PMCID: PMC5663295.