Relation of Gender to Atherosclerotic Plaque Characteristics by Differing Angiographic Stenosis Severity

Rebecca Jonas, Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut. Electronic address: RebeccaArielJonas@gmail.com.
Toral Patel, Department of Cardiology and Advanced Cardiac Imaging, Centra Heart and Vascular Institute, Lynchburg, Virginia.
Tami R. Crabtree, Cleerly, Inc., Denver, Colorado.
Robert S. Jennings, Cleerly, Inc., Denver, Colorado.
Ran Heo, Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Korea College of Medicine, Hanyang University, Seoul, Korea.
Hyung-Bok Park, Division of Cardiology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea.
Hugo Marques, Faculdade de Medicina da Universidade Católica Portuguesa, Lisboa, Portugal.
Hyuk-Jae Chang, Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
Wijnand J. Stuijfzand, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands.
Alexander R. van Rosendael, Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Jung Hyun Choi, Department of Cardiology, Pusan National University Hospital, Busan, South Korea.
Joon-Hyung Doh, Division of Cardiology, Inje University Ilsan Paik Hospital, Goyang, South Korea.
Ae-Young Her, Division of Cardiology, Department of Internal Medicine, Kangwon National University, College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea.
Bon-Kwon Koo, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Chang-Wook Nam, Department of Cardiology, Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, South Korea.
Sang-Hoon Shin, Division of Cardiology, Department of Internal Medicine, Ewha Women's University Seoul Hospital, Seoul, South Korea.
Jason Cole, Mobile Cardiology Associates, Mobile, Alabama.
Alessia Gimelli, Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
Muhammad Akram Khan, Cardiac Center of Texas, McKinney, Texas.
Bin Lu, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China.
Yang Gao, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China.
Faisal Nabi, Department of Cardiology, Houston Methodist Hospital, Houston, Texas.
Mouaz H. Al-Mallah, Department of Cardiology, Houston Methodist Hospital, Houston, Texas.
Ryo Nakazato, Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan.
U Joseph Schoepf, Department of Cardiology, Department of Radiology, Medical University of South Carolina, Charleston, South Carolina.
Roel S. Driessen, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands.
Michiel J. Bom, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands.
Randall C. Thompson, St. Luke's Mid-America Heart Institute, Kansas City, Missouri.
James J. Jang, Kaiser Permanente San Jose Medical Center, San Jose, California.
Michael Ridner, Heart Center Research, LLC, Huntsville, Alabama.
Chris Rowan, Renown Heart and Vascular Institute, Reno, Nevada.
Erick Avelar, Oconee Heart and Vascular Center at St Mary's Hospital, Athens, Georgia.

Document Type

Journal Article

Publication Date

10-1-2023

Journal

The American journal of cardiology

Volume

204

DOI

10.1016/j.amjcard.2023.07.004

Abstract

It is unknown whether gender influences the atherosclerotic plaque characteristics (APCs) of lesions of varying angiographic stenosis severity. This study evaluated the imaging data of 303 symptomatic patients from the derivation arm of the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia) trial, all of whom underwent coronary computed tomographic angiography and clinically indicated nonemergent invasive coronary angiography upon study enrollment. Index tests were interpreted by 2 blinded core laboratories, one of which performed quantitative coronary computed tomographic angiography using an artificial intelligence application to characterize and quantify APCs, including percent atheroma volume (PAV), low-density noncalcified plaque (LD-NCP), noncalcified plaque (NCP), calcified plaque (CP), lesion length, positive arterial remodeling, and high-risk plaque (a combination of LD-NCP and positive remodeling ≥1.10); the other classified lesions as obstructive (≥50% diameter stenosis) or nonobstructive (<50% diameter stenosis) based on quantitative invasive coronary angiography. The relation between APCs and angiographic stenosis was further examined by gender. The mean age of the study cohort was 64.4 ± 10.2 years (29.0% female). In patients with obstructive disease, men had more LD-NCP PAV (0.5 ± 0.4 vs 0.3 ± 0.8, p = 0.03) and women had more CP PAV (11.7 ± 1.6 vs 8.0 ± 0.8, p = 0.04). Obstructive lesions had more NCP PAV compared with their nonobstructive lesions in both genders, however, obstructive lesions in women also demonstrated greater LD-NCP PAV (0.4 ± 0.5 vs 1.0 ± 1.8, p = 0.03), and CP PAV (17.4 ± 16.5 vs 25.9 ± 18.7, p = 0.03) than nonobstructive lesions. Comparing the composition of obstructive lesions by gender, women had more CP PAV (26.3 ± 3.4 vs 15.8 ± 1.5, p = 0.005) whereas men had more NCP PAV (33.0 ± 1.6 vs 26.7 ± 2.5, p = 0.04). Men had more LD-NCP PAV in nonobstructive lesions compared with women (1.2 ± 0.2 vs 0.6 ± 0.2, p = 0.02). In conclusion, there are gender-specific differences in plaque composition based on stenosis severity.

Department

Medicine

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