Abstract 19993: Burden of Coronary Atherosclerosis and Cardiovascular Events in Men and Women with Stable Ischemic Heart Disease
Background: Recent post hoc analyses from COURAGE have identified coronary anatomic burden, but not ischemic burden, as an important predictor of outcomes in patients with stable ischemic heart disease (SIHD). As the pathophysiology of atherosclerosis differs between men and women, we sought to determine if there was likewise a sex-based difference in atherosclerotic burden and cardiovascular outcomes among SIHD patients treated with optimal medical therapy with or without percutaneous coronary intervention.
Methods: At baseline, 2,279 patients who underwent coronary angiography were stratified into 3 subgroups based on the anatomic coronary artery disease (CAD) severity (both by number of diseased epicardial vessels and a myocardial jeopardy score). The 625 patients who underwent baseline stress myocardial perfusion imaging were also similarly stratified by severity of ischemia. Rates of death or myocardial infarction (MI) at 4.6 years, the COURAGE primary endpoint, were compared among men and women in each strata of anatomic or ischemic CAD severity.
Results: While anatomic CAD severity (both by number of diseased vessels and jeopardy score) was significantly correlated with outcomes, severity of ischemia was not. This relationship persisted in both sexes. However, women had significantly higher rates of death/MI and MI alone than men in the subgroup with extensive anatomic CAD (3-vessel disease or high jeopardy score of 4-6) (Table).
Conclusions: In men and women with SIHD treated with intensive lifestyle intervention and pharmacologic therapy, anatomic CAD severity at baseline remained a consistent predictor of long-term cardiovascular events, whereas ischemic severity did not. With severe anatomic CAD, women had a higher incidence of cardiovascular events than men despite having similar angiographic atherosclerotic burden, which was largely driven by a higher rate of nonfatal MI.
Author Disclosures: S. Acharjee: None. W. Boden: None. P. Hartigan: None. K. Teo: None. D. Maron: None. S. Sedlis: None. W. Kostuk: None. J. Spertus: None. M. Dada: None. B. Chaitman: None. G. Mancini: None. W. Weintraub: None.
- © 2014 by American Heart Association, Inc.