AI-Quantitative CT Coronary Plaque Features Associate with a Higher Relative Risk in Women: CONFIRM2-Registry

Gudrun M. Feuchtner, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Pietro G. Lacaita, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Fatima Rodriguez, Stanford University School of Medicine, Cardiovascular Medicine, Paolo Alto, CA.
Rine Nakanishi, Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan.
Gianluca Pontone, Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
Saima Mushtaq, Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
Ronny R. Buechel, Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Zurich, Switzerland.
Christoph Gräni, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Amit R. Patel, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA.
Cristiane C. Singulane, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA.
Andrew D. Choi, Department of Cardiology and Radiology, George Washington University, Washington, DC.
Mouaz Al-Mallah, Department of Cardiology, Houston Methodist, Houston, TX.
Daniele Andreini, Division of University Cardiology, IRCCS Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Italy.
Ronald P. Karlsberg, Cardiovascular Research Foundation of Southern California, Beverly Hills, CA.
Geoffrey W. Cho, Cedars-Sinai Heart, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
Carlos E. Rochitte, Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Mirvat Alasnag, Cardiac Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
Ashraf Hamdan, Department of Cardiology, Rabin Medical Center, Petah Tikva & Tel-Aviv University, Tel-Aviv, Israel, ISRAEL.
Filippo Cademartiri, IRCCS SYNLAB SDN, Naples, Italy.
Erica Maffei, Department of Radiology, Istituto di Ricerca e Cura a Carattere Scientifico SYNLAB SDN, 80131 Naples, Italy.
Hugo Marques, UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal.
Pedro M. Gonçalves Pereira, UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal.
Himanshu Gupta, Cardiac Imaging, Heart and Vascular Institute, Valley Health System, Paramus, NJ.
Martin Hadamitzky, Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.
Omar Khalique, Division of Cardiovascular Imaging, St. Francis Hospital and Heart Center, Roslyn, NY.
Dinesh Kalra, Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY.
James D. Mills, Department of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, WV.
Nick S. Nurmohamed, Department of Cardiology and Department of Vascular Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Paul Knaapen, Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Matthew Budoff, The Lundquist Institute, Torrance, CA.
Kashif Shaikh, University of Tennessee Medical Center, Knoxville, TN.

Document Type

Journal Article

Publication Date

3-31-2025

Journal

Circulation. Cardiovascular imaging

DOI

10.1161/CIRCIMAGING.125.018235

Abstract

Coronary plaque features are imaging biomarkers of cardiovascular risk, but less is known about sex-specific patterns in their prognostic value. This study aimed to define sex differences in the coronary atherosclerotic phenotypes assessed by artificial intelligence-based quantitative coronary computed tomography (AI-QCT) and the associated risk of major adverse cardiovascular events (MACE). Global multicenter registry (CONFIRM2) including symptomatic patients with suspicion of CAD referred for coronary CTA. AI-QCT analyzed 16 CAD features. Primary endpoint was MACE defined as death, myocardial infarction, late revascularization, cerebrovascular events, unstable angina and congestive heart failure. Among 3551 patients (mean age 59±12 years, 49.5% women), MACE occurred in 3.2% of women and 6.1% of men during an average follow-up of 4.8±2.2 years. The AI-QCT features total plaque volume (TPV), noncalcified plaque (NCP), calcified plaque (CP) and percentage atheroma volume (PAV) were significantly higher in men (p<0.001), and high-risk plaque (HRP) was more prevalent (9.2% vs 2.5%, p<0.0001). Independent of age and cardiovascular risk factors, the AI-QCT derived features of TPV, NCP, CP, and PAV conferred a higher relative risk of MACE in women than men. For every 50mm3 increase in TPV, relative risk increased by 17.7% (95% CI 1.12-1.24) in women vs 5.3% (95% CI 1.03-1.07) in men (p-interaction<0.001), for NCP relative risk increased by 27.1% (95% CI 1.17-1.38) vs 11.6% (95% CI 1.08-1.15) (p-interaction = 0.0015), and for CP, by 22.9% (95% CI 1.14-1.33) vs 5.4% (95% CI 1.01-1.10) (p-interaction = 0.0012), respectively. Similarly, for PAV the risk was higher in women. The findings remained unchanged when restricted to a secondary composite endpoint (death and myocardial infarction). The AI-QCT plaque features TPV, NCP, CP and PAV conferred a higher relative MACE risk in women and may prompt more aggressive anti-atherosclerotic therapy and reinforced preventive interventions.

Department

Radiology

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