Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction

Michelle C. Williams; Jacek Kwiecinski; Mhairi Doris; Priscilla McElhinney; Michelle S. D’Souza; Sebastien Cadet; Philip D. Adamson; Alastair J. Moss; Shirjel Alam; Amanda Hunter; Anoop S. V. Shah; Nicholas L. Mills; Tania Pawade; Chengjia Wang; Jonathan R. Weir Mccall; Michael Bonnici-Mallia; Christopher Murrills; Giles Roditi; Edwin J. R. Van Beek; Leslee J. Shaw; Edward D. Nicol; Daniel S. Berman; Piotr J. Slomka; David E. Newby; Marc R. Dweck; Damini Dey

doi:10.1016/j.jcmg.2021.03.004

Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction

Michelle C. Williams (Lead / Corresponding author), Jacek Kwiecinski, Mhairi Doris, Priscilla McElhinney, Michelle S. D’Souza, Sebastien Cadet, Philip D. Adamson, Alastair J. Moss, Shirjel Alam, Amanda Hunter, Anoop S. V. Shah, Nicholas L. Mills, Tania Pawade, Chengjia Wang, Jonathan R. Weir Mccall, Michael Bonnici-Mallia, Christopher Murrills, Giles Roditi, Edwin J. R. Van Beek, Leslee J. ShawEdward D. Nicol, Daniel S. Berman, Piotr J. Slomka, David E. Newby, Marc R. Dweck, Damini Dey

Research output: Contribution to journal › Article › peer-review

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Abstract

Objectives: This study was designed to investigate whether coronary computed tomography angiography assessments of coronary plaque might explain differences in the prognosis of men and women presenting with chest pain. Background: Important sex differences exist in coronary artery disease. Women presenting with chest pain have different risk factors, symptoms, prevalence of coronary artery disease and prognosis compared to men.

Methods: Within a multicenter randomized controlled trial, we explored sex differences in stenosis, adverse plaque characteristics (positive remodeling, low-attenuation plaque, spotty calcification, or napkin ring sign) and quantitative assessment of total, calcified, noncalcified and low-attenuation plaque burden.

Results: Of the 1,769 participants who underwent coronary computed tomography angiography, 772 (43%) were female. Women were more likely to have normal coronary arteries and less likely to have adverse plaque characteristics (p < 0.001 for all). They had lower total, calcified, noncalcified, and low-attenuation plaque burdens (p < 0.001 for all) and were less likely to have a low-attenuation plaque burden >4% (41% vs. 59%; p < 0.001). Over a median follow-up of 4.7 years, myocardial infarction (MI) occurred in 11 women (1.4%) and 30 men (3%). In those who had MI, women had similar total, noncalcified, and low-attenuation plaque burdens as men, but men had higher calcified plaque burden. Low-attenuation plaque burden predicted MI (hazard ratio: 1.60; 95% confidence interval: 1.10 to 2.34; p = 0.015), independent of calcium score, obstructive disease, cardiovascular risk score, and sex.

Conclusions: Women presenting with stable chest pain have less atherosclerotic plaque of all subtypes compared to men and a lower risk of subsequent MI. However, quantitative low-attenuation plaque is as strong a predictor of subsequent MI in women as in men. (Scottish Computed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).

Original language	English
Pages (from-to)	1804-1814
Number of pages	11
Journal	JACC: Cardiovascular Imaging
Volume	14
Issue number	9
Early online date	14 Apr 2021
DOIs	https://doi.org/10.1016/j.jcmg.2021.03.004
Publication status	Published - Sept 2021

Keywords

computed tomography
computed tomography coronary angiography
coronary artery disease
quantitative plaque analysis
sex

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

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Williams, M. C., Kwiecinski, J., Doris, M., McElhinney, P., D’Souza, M. S., Cadet, S., Adamson, P. D., Moss, A. J., Alam, S., Hunter, A., Shah, A. S. V., Mills, N. L., Pawade, T., Wang, C., Weir Mccall, J. R., Bonnici-Mallia, M., Murrills, C., Roditi, G., Van Beek, E. J. R., ... Dey, D. (2021). Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction. JACC: Cardiovascular Imaging, 14(9), 1804-1814. https://doi.org/10.1016/j.jcmg.2021.03.004

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title = "Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction",

abstract = "Objectives: This study was designed to investigate whether coronary computed tomography angiography assessments of coronary plaque might explain differences in the prognosis of men and women presenting with chest pain. Background: Important sex differences exist in coronary artery disease. Women presenting with chest pain have different risk factors, symptoms, prevalence of coronary artery disease and prognosis compared to men.Methods: Within a multicenter randomized controlled trial, we explored sex differences in stenosis, adverse plaque characteristics (positive remodeling, low-attenuation plaque, spotty calcification, or napkin ring sign) and quantitative assessment of total, calcified, noncalcified and low-attenuation plaque burden.Results: Of the 1,769 participants who underwent coronary computed tomography angiography, 772 (43%) were female. Women were more likely to have normal coronary arteries and less likely to have adverse plaque characteristics (p < 0.001 for all). They had lower total, calcified, noncalcified, and low-attenuation plaque burdens (p < 0.001 for all) and were less likely to have a low-attenuation plaque burden >4% (41% vs. 59%; p < 0.001). Over a median follow-up of 4.7 years, myocardial infarction (MI) occurred in 11 women (1.4%) and 30 men (3%). In those who had MI, women had similar total, noncalcified, and low-attenuation plaque burdens as men, but men had higher calcified plaque burden. Low-attenuation plaque burden predicted MI (hazard ratio: 1.60; 95% confidence interval: 1.10 to 2.34; p = 0.015), independent of calcium score, obstructive disease, cardiovascular risk score, and sex.Conclusions: Women presenting with stable chest pain have less atherosclerotic plaque of all subtypes compared to men and a lower risk of subsequent MI. However, quantitative low-attenuation plaque is as strong a predictor of subsequent MI in women as in men. (Scottish Computed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).",

keywords = "computed tomography, computed tomography coronary angiography, coronary artery disease, quantitative plaque analysis, sex",

author = "Williams, {Michelle C.} and Jacek Kwiecinski and Mhairi Doris and Priscilla McElhinney and D{\textquoteright}Souza, {Michelle S.} and Sebastien Cadet and Adamson, {Philip D.} and Moss, {Alastair J.} and Shirjel Alam and Amanda Hunter and Shah, {Anoop S. V.} and Mills, {Nicholas L.} and Tania Pawade and Chengjia Wang and {Weir Mccall}, {Jonathan R.} and Michael Bonnici-Mallia and Christopher Murrills and Giles Roditi and {Van Beek}, {Edwin J. R.} and Shaw, {Leslee J.} and Nicol, {Edward D.} and Berman, {Daniel S.} and Slomka, {Piotr J.} and Newby, {David E.} and Dweck, {Marc R.} and Damini Dey",

note = "Funding Information: Drs. Dey, Slomka, and Berman and Mr. Cadet may receive software royalties from Cedars-Sinai Medical Center; and Drs. Dey, Slomka, and Berman have a patent. This trial was funded by The Chief Scientist Office of the Scottish Government Health and Social Care Directorates (CZH/4/588), with supplementary awards from Edinburgh and Lothian{\textquoteright}s Health Foundation Trust and the Heart Diseases Research Fund. Drs. Williams, Mills, Newby, and Dweck are supported by the British Heart Foundation (FS/ICRF/20/26002, CH/09/002, FS/11/014, FS/16/14/32023, RG/20/10/34966, RE/18/5/34216, RG/16/10/32375, FS/14/78/31020). Dr. Williams was supported by The Chief Scientist Office of the Scottish Government Health (PCL/17/04). Dr. Newby is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). Dr. van Beek is supported by Scottish Imaging Network: A Platform of Scientific Excellence (SINAPSE). Dr. Adamson is supported by a National Heart Foundation of New Zealand Senior Fellowship (1844). Dr. Dweck is supported by the Sir Jules Thorn Biomedical Research Award 2015 (15/JTA). The Royal Bank of Scotland supported the provision of 320-multidetector CT for NHS Lothian and the University of Edinburgh. The Edinburgh Imaging facility QMRI (Edinburgh) is supported by the National Health Service Research Scotland (NRS) through National Health Service Lothian Health Board. The Clinical Research Facility Glasgow and Clinical Research Facility Tayside are supported by National Health Service Research Scotland (NRS). Ms. McElhinney and Dr. Dey are supported by National Institute of Health/National Heart, Lung, and Blood Institute grants (1R01HL148787-01A1 and 1R01HL151266). Mr. Cadet is supported by the Miriam and Sheldon G. Adelson Medical Research Foundation. All other authors have no reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2021 American College of Cardiology Foundation",

year = "2021",

month = sep,

doi = "10.1016/j.jcmg.2021.03.004",

language = "English",

volume = "14",

pages = "1804--1814",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier",

number = "9",

}

Williams, MC, Kwiecinski, J, Doris, M, McElhinney, P, D’Souza, MS, Cadet, S, Adamson, PD, Moss, AJ, Alam, S, Hunter, A, Shah, ASV, Mills, NL, Pawade, T, Wang, C, Weir Mccall, JR, Bonnici-Mallia, M, Murrills, C, Roditi, G, Van Beek, EJR, Shaw, LJ, Nicol, ED, Berman, DS, Slomka, PJ, Newby, DE, Dweck, MR & Dey, D 2021, 'Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction', JACC: Cardiovascular Imaging, vol. 14, no. 9, pp. 1804-1814. https://doi.org/10.1016/j.jcmg.2021.03.004

TY - JOUR

T1 - Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction

AU - Williams, Michelle C.

AU - Kwiecinski, Jacek

AU - Doris, Mhairi

AU - McElhinney, Priscilla

AU - D’Souza, Michelle S.

AU - Cadet, Sebastien

AU - Adamson, Philip D.

AU - Moss, Alastair J.

AU - Alam, Shirjel

AU - Hunter, Amanda

AU - Shah, Anoop S. V.

AU - Mills, Nicholas L.

AU - Pawade, Tania

AU - Wang, Chengjia

AU - Weir Mccall, Jonathan R.

AU - Bonnici-Mallia, Michael

AU - Murrills, Christopher

AU - Roditi, Giles

AU - Van Beek, Edwin J. R.

AU - Shaw, Leslee J.

AU - Nicol, Edward D.

AU - Berman, Daniel S.

AU - Slomka, Piotr J.

AU - Newby, David E.

AU - Dweck, Marc R.

AU - Dey, Damini

N1 - Funding Information: Drs. Dey, Slomka, and Berman and Mr. Cadet may receive software royalties from Cedars-Sinai Medical Center; and Drs. Dey, Slomka, and Berman have a patent. This trial was funded by The Chief Scientist Office of the Scottish Government Health and Social Care Directorates (CZH/4/588), with supplementary awards from Edinburgh and Lothian’s Health Foundation Trust and the Heart Diseases Research Fund. Drs. Williams, Mills, Newby, and Dweck are supported by the British Heart Foundation (FS/ICRF/20/26002, CH/09/002, FS/11/014, FS/16/14/32023, RG/20/10/34966, RE/18/5/34216, RG/16/10/32375, FS/14/78/31020). Dr. Williams was supported by The Chief Scientist Office of the Scottish Government Health (PCL/17/04). Dr. Newby is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). Dr. van Beek is supported by Scottish Imaging Network: A Platform of Scientific Excellence (SINAPSE). Dr. Adamson is supported by a National Heart Foundation of New Zealand Senior Fellowship (1844). Dr. Dweck is supported by the Sir Jules Thorn Biomedical Research Award 2015 (15/JTA). The Royal Bank of Scotland supported the provision of 320-multidetector CT for NHS Lothian and the University of Edinburgh. The Edinburgh Imaging facility QMRI (Edinburgh) is supported by the National Health Service Research Scotland (NRS) through National Health Service Lothian Health Board. The Clinical Research Facility Glasgow and Clinical Research Facility Tayside are supported by National Health Service Research Scotland (NRS). Ms. McElhinney and Dr. Dey are supported by National Institute of Health/National Heart, Lung, and Blood Institute grants (1R01HL148787-01A1 and 1R01HL151266). Mr. Cadet is supported by the Miriam and Sheldon G. Adelson Medical Research Foundation. All other authors have no reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2021 American College of Cardiology Foundation

PY - 2021/9

Y1 - 2021/9

N2 - Objectives: This study was designed to investigate whether coronary computed tomography angiography assessments of coronary plaque might explain differences in the prognosis of men and women presenting with chest pain. Background: Important sex differences exist in coronary artery disease. Women presenting with chest pain have different risk factors, symptoms, prevalence of coronary artery disease and prognosis compared to men.Methods: Within a multicenter randomized controlled trial, we explored sex differences in stenosis, adverse plaque characteristics (positive remodeling, low-attenuation plaque, spotty calcification, or napkin ring sign) and quantitative assessment of total, calcified, noncalcified and low-attenuation plaque burden.Results: Of the 1,769 participants who underwent coronary computed tomography angiography, 772 (43%) were female. Women were more likely to have normal coronary arteries and less likely to have adverse plaque characteristics (p < 0.001 for all). They had lower total, calcified, noncalcified, and low-attenuation plaque burdens (p < 0.001 for all) and were less likely to have a low-attenuation plaque burden >4% (41% vs. 59%; p < 0.001). Over a median follow-up of 4.7 years, myocardial infarction (MI) occurred in 11 women (1.4%) and 30 men (3%). In those who had MI, women had similar total, noncalcified, and low-attenuation plaque burdens as men, but men had higher calcified plaque burden. Low-attenuation plaque burden predicted MI (hazard ratio: 1.60; 95% confidence interval: 1.10 to 2.34; p = 0.015), independent of calcium score, obstructive disease, cardiovascular risk score, and sex.Conclusions: Women presenting with stable chest pain have less atherosclerotic plaque of all subtypes compared to men and a lower risk of subsequent MI. However, quantitative low-attenuation plaque is as strong a predictor of subsequent MI in women as in men. (Scottish Computed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).

AB - Objectives: This study was designed to investigate whether coronary computed tomography angiography assessments of coronary plaque might explain differences in the prognosis of men and women presenting with chest pain. Background: Important sex differences exist in coronary artery disease. Women presenting with chest pain have different risk factors, symptoms, prevalence of coronary artery disease and prognosis compared to men.Methods: Within a multicenter randomized controlled trial, we explored sex differences in stenosis, adverse plaque characteristics (positive remodeling, low-attenuation plaque, spotty calcification, or napkin ring sign) and quantitative assessment of total, calcified, noncalcified and low-attenuation plaque burden.Results: Of the 1,769 participants who underwent coronary computed tomography angiography, 772 (43%) were female. Women were more likely to have normal coronary arteries and less likely to have adverse plaque characteristics (p < 0.001 for all). They had lower total, calcified, noncalcified, and low-attenuation plaque burdens (p < 0.001 for all) and were less likely to have a low-attenuation plaque burden >4% (41% vs. 59%; p < 0.001). Over a median follow-up of 4.7 years, myocardial infarction (MI) occurred in 11 women (1.4%) and 30 men (3%). In those who had MI, women had similar total, noncalcified, and low-attenuation plaque burdens as men, but men had higher calcified plaque burden. Low-attenuation plaque burden predicted MI (hazard ratio: 1.60; 95% confidence interval: 1.10 to 2.34; p = 0.015), independent of calcium score, obstructive disease, cardiovascular risk score, and sex.Conclusions: Women presenting with stable chest pain have less atherosclerotic plaque of all subtypes compared to men and a lower risk of subsequent MI. However, quantitative low-attenuation plaque is as strong a predictor of subsequent MI in women as in men. (Scottish Computed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).

KW - computed tomography

KW - computed tomography coronary angiography

KW - coronary artery disease

KW - quantitative plaque analysis

KW - sex

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U2 - 10.1016/j.jcmg.2021.03.004

DO - 10.1016/j.jcmg.2021.03.004

M3 - Article

C2 - 33865779

SN - 1936-878X

VL - 14

SP - 1804

EP - 1814

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 9

ER -

Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction

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