John William Nance MD, Presenter: Nothing to Disclose

U. Joseph Schoepf MD, Abstract Co-Author: Speakers Bureau, Bayer AG Speakers Bureau, Siemens AG Medical Advisory Board, Bayer AG Research grant, Bayer AG Research grant, Bracco Group Research grant, General Electric Company Research grant, Siemens AG

Christopher L. Schlett MD, Abstract Co-Author: Research grant, General Electric Company

Garrett W. Rowe BS, Abstract Co-Author: Nothing to Disclose

J. Michael Barraza BS, Abstract Co-Author: Nothing to Disclose

Fabian Bamberg MD, MPH, Abstract Co-Author: Nothing to Disclose

To determine differences in the predictive value associated with findings on cardiac CT angiography (CTA) for the occurrence of cardiovascular events between women and men presenting with acute chest pain but absence of acute coronary syndrome.

Subjects with acute chest pain underwent contrast enhanced CTA. The presence, extent (expressed as the number of affected vessel segments), severity (≥50% or <50% stenosis), and composition of atherosclerotic lesions (calcified, non-calcified, or mixed) were determined by independent readers. Patients were followed for major adverse cardiac events (MACE: myocardial infarction, unstable angina, revascularization, cardiac death). Hazard ratios were derived using univariate and multivariate cox regression (after adjustment for traditional risk factors) and stratified by gender if there was a statistically significant interaction (p<0.01).

480 subjects (mean age: 55±11 years, 35% male) presenting with acute chest pain but without acute coronary syndrome were included. During a follow-up period of 12.8±7.0 months, 87 events occurred in 70 patients (3 cardiac deaths, 13 myocardial infarctions, 33 revascularizations, and 38 cases of unstable angina). There were significant differences with respect to gender and presence and extent of plaque and stenosis between subjects with and without MACE (all p<0.01). In women, the risk associated with the presence of any plaque was significantly higher than in men (hazard ratio: 49.3 vs. hazard ratio: 39.1, both p<0.001) as compared to subjects without any plaque. Also, the risk associated with >4 coronary segments of any plaque was significantly higher in women than in men (hazard ratio: 113.9 vs. hazard ratio: 66.9, both p<0.01) as compared to subjects without any plaque. In contrast, each segment containing non-calcified plaque had a higher risk in men compared to women (hazard ratio: 1.55 vs. hazard ratio: 2.2, respectively, both p<0.01).

The risk for cardiovascular events associated with the presence, extent, and composition of atherosclerotic plaque as measured by CTA differs between women and men. The presence of any plaque and of more extensive atherosclerosis portends a significantly higher cardiovascular risk in women than in men, whereas findings of non-calcified plaque are more predictive of MACE in men.

These aspects should be considered when performing risk stratification in these patients.

Nance, J, Schoepf, U, Schlett, C, Rowe, G, Barraza, J, Bamberg, F, Gender Differences in the Predictive Value of the Presence, Extent, and Composition of Coronary Atherosclerotic Plaque as Measured by Cardiac CT Angiography.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11012905.html