Nonobstructive Left Main Coronary Artery Disease Predicts Risk of Adverse Outcomes in Women
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
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.
Click on any of these tags to subscribe to Topic Alerts. Once subscribed, you can get a single, daily email any time PracticeUpdate publishes content on the topics that interest you.
Visit your Preferences and Settings section to Manage All Topic Alerts
Additional Info
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 01;10(8)e006246, JX Xie, P Eshtehardi, T Varghese, A Goyal, PK Mehta, W Kang, J Leipsic, B Ó Hartaigh, CN Bairey Merz, DS Berman, H Gransar, MJ Budoff, S Achenbach, TQ Callister, H Marques, R Rubinshtein, MH Al-Mallah, D Andreini, G Pontone, F Cademartiri, E Maffei, K Chinnaiyan, G Raff, M Hadamitzky, J Hausleiter, G Feuchtner, PA Kaufmann, TC Villines, BJW Chow, JK Min, LJ ShawFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.