Abstract 13042: Invasive Coronary Angiography, Revascularization, and Adverse Cardiac Events Following CCTA: A Matched Analysis of Women and Men in the Prospective Multinational CONFIRM Registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry)
Background. Women experience higher event rates and worsened prognosis after coronary revascularization (REV) compared to men. Whether these disparities occur as a result of gender-specific differences in REV or coronary atherosclerosis remains unknown. We studied in a large multinational registry of patients undergoing coronary computed tomographic angiography (CCTA) gender-specific event rates in women and men who were matched for extent and severity of coronary atherosclerosis.
Methods. The study population comprised 15,215 consecutive patients without known coronary artery disease (CAD) undergoing CCTA for whom complete follow-up for invasive coronary angiography (ICA), REV and MACE (death and non- fatal myocardial infarction) were available. By CCTA, per-patient extent and severity of CAD was determined, and rated as none, non-obstructive (1-49% stenosis) or obstructive (>50% stenosis) in 1-, 2-, or 3-vessels. Left main coronary stenosis >50% was considered equivalent to 3-vessel obstructive CAD. 1:1 matching by CAD severity was successfully performed, resulting in 6191 women matched to 6191 men.
Results. Non-obstructive CAD, 1-vessel, 2-vessel, and 3-vessel CAD disease were present in 34.3%, 9.5%, 3.1% and 1.3% of the matched cohorts, respectively. 11.3% underwent ICA, 5.5% underwent REV, and 2.3% experienced MACE over a 2.3±1.2 year follow-up. Matched women were older (59.1 ± 11.2 vs 53.6 ± 12.1 years); possessed greater numbers of CAD risk factors; and had higher rates of typical angina (11.6% vs 8.8%) and dyspnea (32.1% vs 19.7%). Women were equally likely to be referred to ICA (11.3% vs 11.3%, p=0.92) and REV (5.2% vs 5.9%, p=0.06), but experienced significantly higher MACE rates than men (2.6% vs 2.0%, p=0.02). After adjustment for age, CAD risk factors, CAD and revascularization, while young women had similar risk to men, every decade of older age among women conferred increased hazard of MACE compared to men (HR 1.04, 95% CI 1.002, 1.08, p = 0.04 for interaction).
Conclusion: When matched for extent and severity of CAD, women and men experience similar referral rates to ICA and REV, but older women are still at greater risk for incident MACE than men and younger women. More intensive management of older women with CAD may be warranted.
- © 2011 by American Heart Association, Inc.