Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry
Main Author: | |
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Publication Date: | 2016 |
Other Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format: | Article |
Language: | eng |
Source: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Download full: | http://hdl.handle.net/10400.17/2755 |
Summary: | 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. |
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Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term RegistryAgedComputed Tomography AngiographyCoronary AngiographyCoronary Artery DiseaseCoronary StenosisDisease ProgressionEuropeFemaleFollow-Up StudiesHumansIncidenceKaplan-Meier EstimateMaleMiddle AgedMultidetector Computed TomographyMyocardial InfarctionNorth AmericaPredictive Value of TestsPrevalencePrognosisProportional Hazards ModelsProspective StudiesRegistriesRepublic of KoreaRisk FactorsSeverity of Illness IndexSex DistributionSex FactorsTime FactorsCoronary VesselsPlaque, AtheroscleroticHCC CIROBJECTIVES: 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.ElsevierRepositório do Centro Hospitalar Universitário de Lisboa Central, EPESchulman-Marcus, JHartaigh, BGransar, HLin, FValenti, VCho, IBerman, DCallister, TDeLago, AHadamitzky, MHausleiter, JAl-Mallah, MBudoff, MKaufmann, PAchenbach, SRaff, GChinnaiyan, KCademartiri, FMaffei, EVillines, TKim, YLeipsic, JFeuchtner, GRubinshtein, RPontone, GAndreini, DMarques, HShaw, LMin, J2017-09-21T11:33:17Z2016-042016-04-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/2755engJACC Cardiovasc Imaging. 2016 Apr;9(4):364-37210.1016/j.jcmg.2016.02.010info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:39:27Zoai:repositorio.chlc.min-saude.pt:10400.17/2755Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:20:05.326467Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry |
title |
Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry |
spellingShingle |
Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry Schulman-Marcus, J Aged Computed Tomography Angiography Coronary Angiography Coronary Artery Disease Coronary Stenosis Disease Progression Europe Female Follow-Up Studies Humans Incidence Kaplan-Meier Estimate Male Middle Aged Multidetector Computed Tomography Myocardial Infarction North America Predictive Value of Tests Prevalence Prognosis Proportional Hazards Models Prospective Studies Registries Republic of Korea Risk Factors Severity of Illness Index Sex Distribution Sex Factors Time Factors Coronary Vessels Plaque, Atherosclerotic HCC CIR |
title_short |
Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry |
title_full |
Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry |
title_fullStr |
Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry |
title_full_unstemmed |
Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry |
title_sort |
Sex-Specific Associations Between Coronary Artery Plaque Extent and Risk of Major Adverse Cardiovascular Events: The CONFIRM Long-Term Registry |
author |
Schulman-Marcus, J |
author_facet |
Schulman-Marcus, J Hartaigh, B 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 Villines, T Kim, Y Leipsic, J Feuchtner, G Rubinshtein, R Pontone, G Andreini, D Marques, H Shaw, L Min, J |
author_role |
author |
author2 |
Hartaigh, B 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 Villines, T Kim, Y Leipsic, J Feuchtner, G Rubinshtein, R Pontone, G Andreini, D Marques, H Shaw, L Min, J |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Schulman-Marcus, J Hartaigh, B 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 Villines, T Kim, Y Leipsic, J Feuchtner, G Rubinshtein, R Pontone, G Andreini, D Marques, H Shaw, L Min, J |
dc.subject.por.fl_str_mv |
Aged Computed Tomography Angiography Coronary Angiography Coronary Artery Disease Coronary Stenosis Disease Progression Europe Female Follow-Up Studies Humans Incidence Kaplan-Meier Estimate Male Middle Aged Multidetector Computed Tomography Myocardial Infarction North America Predictive Value of Tests Prevalence Prognosis Proportional Hazards Models Prospective Studies Registries Republic of Korea Risk Factors Severity of Illness Index Sex Distribution Sex Factors Time Factors Coronary Vessels Plaque, Atherosclerotic HCC CIR |
topic |
Aged Computed Tomography Angiography Coronary Angiography Coronary Artery Disease Coronary Stenosis Disease Progression Europe Female Follow-Up Studies Humans Incidence Kaplan-Meier Estimate Male Middle Aged Multidetector Computed Tomography Myocardial Infarction North America Predictive Value of Tests Prevalence Prognosis Proportional Hazards Models Prospective Studies Registries Republic of Korea Risk Factors Severity of Illness Index Sex Distribution Sex Factors Time Factors Coronary Vessels Plaque, Atherosclerotic HCC CIR |
description |
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. |
publishDate |
2016 |
dc.date.none.fl_str_mv |
2016-04 2016-04-01T00:00:00Z 2017-09-21T11:33:17Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/2755 |
url |
http://hdl.handle.net/10400.17/2755 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
JACC Cardiovasc Imaging. 2016 Apr;9(4):364-372 10.1016/j.jcmg.2016.02.010 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Elsevier |
publisher.none.fl_str_mv |
Elsevier |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799131297056030721 |