性别特异性 CT 冠状动脉斑块特征与心肌梗死风险。
Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction.
机构信息
BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, United Kingdom.
BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
出版信息
JACC Cardiovasc Imaging. 2021 Sep;14(9):1804-1814. doi: 10.1016/j.jcmg.2021.03.004. Epub 2021 Apr 14.
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).
目的
本研究旨在探讨冠状动脉 CT 血管造影（CCTA）对冠状动脉斑块的评估是否可以解释男女胸痛患者预后的差异。
背景
在冠状动脉疾病中存在重要的性别差异。与男性相比，女性胸痛患者的危险因素、症状、冠状动脉疾病的患病率和预后均不同。
方法
在一项多中心随机对照试验中，我们探讨了狭窄、不良斑块特征（正性重构、低衰减斑块、点状钙化或餐巾环征）以及总、钙化、非钙化和低衰减斑块负荷的定量评估方面的性别差异。
结果
在 1769 名接受 CCTA 的患者中，772 名（43%）为女性。女性更有可能存在正常冠状动脉，且不良斑块特征的发生率更低（所有差异均 p < 0.001）。女性的总斑块、钙化斑块、非钙化斑块和低衰减斑块负荷均较低（所有差异均 p < 0.001），且低衰减斑块负荷 >4%的可能性更小（41%比 59%；p < 0.001）。中位随访 4.7 年后，11 名女性（1.4%）和 30 名男性（3%）发生心肌梗死（MI）。在发生 MI 的患者中，女性的总斑块、非钙化斑块和低衰减斑块负荷与男性相似，但男性的钙化斑块负荷更高。低衰减斑块负荷可预测 MI（危险比：1.60；95%置信区间：1.10 至 2.34；p = 0.015），独立于钙评分、阻塞性疾病、心血管风险评分和性别。
结论
与男性相比，稳定胸痛的女性具有所有类型斑块的程度均较低，且随后发生 MI 的风险较低。然而，定量低衰减斑块对女性和男性后续 MI 的预测作用同样强。（苏格兰 CT 心脏研究 [SCOT-HEART]；NCT01149590）
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