Sex-based prognostic implications of nonobstructive coronary artery disease: Results from the international multicenter CONFIRM study

Jonathon Leipsic, Carolyn M. Taylor, Heidi Gransar, Leslee J. Shaw, Amir Ahmadi, Angus Thompson, Karin Humphries, Daniel S. Berman, Jörg Hausleiter, Stephan Achenbach, Mouaz Al-Mallah, Matthew J. Budoff, Fillippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Benjamin J.W. Chow, Ricardo C. Cury, Augustin J. Delago, Allison L. Dunning, Gudrun M. FeuchtnerMartin Hadamitzky, Philipp A. Kaufmann, Fay Y. Lin, Kavitha M. Chinnaiyan, Erica Maffei, Gilbert L. Raff, Todd C. Villines, Millie J. Gomez, James K. Min

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Abstract

Purpose: To determine the clinical outcomes of women and men with nonobstructive coronary artery disease (CAD) with coronary computed tomographic (CT) angiography data in patients who were similar in terms of CAD risk factors, angina typicality, and CAD extent and distribution.

Materials and Methods: Institutional review board approval was obtained for all participating sites, with either informed consent or waiver of informed consent. In a prospective international multicenter cohort study of 27 125 patients undergoing coronary CT angiography at 12 centers, 18 158 patients with no CAD or nonobstructive (< 50% stenosis) CAD were examined. Men and women were propensity matched for age, CAD risk factors, angina typicality, and CAD extent and distribution, which resulted in a final cohort of 11 462 subjects. Nonobstructive CAD presence and extent were related to incident major adverse cardiovascular events (MACE), which were inclusive of death and myocardial infarction and were estimated by using multivariable Cox proportional hazards models.

Results: At a mean follow-up±standard deviation of 2.3 years±1.1, MACE occurred in 164 patients (0.6% annual event rate). After matching, women and men experienced identical annualized rates of myocardial infarction (0.2% vs 0.2%, P = .72), death (0.5% vs 0.5%, P = .98), and MACE (0.6% vs 0.6%, P = .94). In multivariable analysis, nonobstructive CAD was associated with similarly increased MACE for both women (hazard ratio: 1.96 [95% confidence interval {CI}: 1.17, 3.28], P = .01) and men (hazard ratio: 1.77 [95% CI: 1.07, 2.93], P = .03).

Conclusion: When matched for age, CAD risk factors, angina typicality, and nonobstructive CAD extent, women and men experience comparable rates of incident mortality and myocardial infarction.

Original languageEnglish
Pages (from-to)393-400
Number of pages8
JournalRadiology
Volume273
Issue number2
DOIs
Publication statusPublished - 2014 Nov 1

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All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Leipsic, J., Taylor, C. M., Gransar, H., Shaw, L. J., Ahmadi, A., Thompson, A., Humphries, K., Berman, D. S., Hausleiter, J., Achenbach, S., Al-Mallah, M., Budoff, M. J., Cademartiri, F., Callister, T. Q., Chang, H. J., Chow, B. J. W., Cury, R. C., Delago, A. J., Dunning, A. L., ... Min, J. K. (2014). Sex-based prognostic implications of nonobstructive coronary artery disease: Results from the international multicenter CONFIRM study. Radiology, 273(2), 393-400. https://doi.org/10.1148/radiol.14140269