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Gender-specific differences in obstructive coronary artery disease by coronary CT angiography
Session:
Posters (Sessão 1 - Écran 1) - Imagem 1 - TC Cardíaca e Cardiologia Nuclear
Speaker:
Ana Filipa Abreu Cardoso
Congress:
CPC 2022
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Ana Filipa Cardoso; Paulo Pereira; Nuno Ferreira; Rita Faria; Wilson Ferreira; Mónica Carvalho; António Lourenço; Ricardo Fontes-Carvalho; Ricardo Ladeiras-Lopes
Abstract
<p><strong>Introduction:</strong> Gender affects coronary artery disease (CAD) presentation. However, its impact in the atherosclerotic findings by coronary CT angiography (CCTA) in obstructive CAD is less described. Our aim was to evaluate gender differences in the clinical profile and atherosclerotic findings on CCTA in patients with obstructive CAD.</p> <p><strong>Methods: </strong>Single-centre retrospective cohort study of patients with no known CAD who performed a CCTA from January 2017 to May 2021. Patients with obstructive CAD on CCTA (CAD-RADS classification of 4A/4B/5) were included. Coronary artery calcium score (CACS) was calculated using the Agatston method.</p> <p>A comparative analysis between females and males was performed.</p> <p>A combined endpoint (EP) of acute coronary syndrome (ACS), coronary revascularization by percutaneous coronary intervention (PCI) or surgery (CABG) and cardiovascular (CV) death was evaluated during the follow-up.</p> <p><strong>Results:</strong> From a total of 3436 exams, 298 (9%) patients with obstructive CAD were identified. Mean age was 60±9 years and 81 (27%) were women.</p> <p>Females with obstructive CAD were older (64±7 vs 59±10 years, p <0.001). Their comorbidities were similar, except for a lower prevalence of smoking habits (15% vs 43%, p<0.001). They had more complaints of chest pain (77% vs 61%, p=0.011), but similar rates of typical angina (32% vs 24%, p=0.182). Their pre-test probability of obstructive CAD (according to the new ESC model) was lower (11%, IQR 6-16 vs 22%, IQR 12-27, p=0.010).</p> <p>Women had a lower median CACS (133 AU, IQR 30-348 vs 194 AU, IQR 67-422; p=0.045). This included 19% of females with a CASC<10AU in comparison to only 10% of males (p=0.039). A lower calcium volume (119 mm3, IQR 34-219 vs 186 mm3, IQR 67-403; p=0.014) was identified. Calcium density score was similar (p=0.243)</p> <p>Females had less multivessel disease on CTTA (19% vs 30%, p=0.035).</p> <p>An invasive coronary angiogram was performed in 229 (77%) patients, including 67 women (p=0.142).</p> <p>During a median follow-up of 29 (IQR 14-43) months, 126 (42%) patients had the combined EP (7 ACS; 92 PCI and 27 CABG). There were no CV deaths. The combined EP occurred in a similar proportion in both groups.</p> <p><strong>Conclusion: </strong>In this study, almost 1 out of 5 women with obstructive CAD had a CACS <10 AU. They had a lower pre-test probability of obstructive CAD, lower CACS and less multivessel disease. Different pathophysiology mechanisms of CAD may justify these differences, which should be taken into account when evaluating these patients.</p>
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