Abstract 17484: Risk of Myocardial Infarction Among Women versus Men With Nonobstructive Left Main Coronary Artery Disease
Introduction: Nonobstructive (1-49% stenosis) coronary artery disease (CAD) is more frequently detected in women than men with ANOCA (angina, no obstructive CAD) and is associated with increased myocardial infarction (MI) risk. However, nonobstructive CAD in the left main (LM) has not been previously assessed, and sex-specific outcomes with nonobstructive LM are unknown.
Methods: In the 5-year COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, patients with suspected stable CAD underwent coronary computed tomographic angiography (CCTA) and were categorized as having no LM stenosis, nonobstructive LM, or obstructive LM. Kaplan-Meier survival analysis and multivariable Cox regression were used to assess sex-specific associations for LM strata and incident MI (n=678).
Results: Among 2,138 women and 4,134 men, 14 vs 20% (p<0.01) had nonobstructive LM, and 2 vs 4% (p<0.01) had obstructive LM. 5-year cumulative MI incidence among patients with no LM, nonobstructive LM, and obstructive LM, respectively, were 9%, 16%, and 26% for women (p<0.01) and 10%, 13%, and 21% for men (p<0.01). Compared to no LM, obstructive LM was associated with the highest MI risk in both women (adjusted HR 2.23, p=0.02) and men (adjusted HR 1.72, p=0.01). However, nonobstructive LM also strongly increased MI risk in women (adjusted HR 1.68, p<0.01) but not in men (adjusted HR 1.18, p=0.16). Even among patients without any obstructive CAD, cumulative MI rates were higher in women with nonobstructive LM (p<0.01) but not in men (p=0.44) (Figure). Importantly, nonobstructive LM doubled the MI risk among women in this subset (adjusted HR 2.07, p=0.01) but did not increase risk among men (adjusted HR 0.99, p=0.95).
Conclusions: Nonobstructive LM should be differentially highlighted among women as a high risk finding and potentially contributing to sex-related disparities among patients with nonobstructive CAD.
Author Disclosures: J.X. Xie: None. T. Varghese: None. P.K. Mehta: None. J. Leipsic: None. C. Bairey Merz: None. D.S. Berman: None. M.J. Budoff: None. S. Achenbach: None. A. Dunning: None. H. Gransar: None. T.Q. Callister: None. A. Delago: None. H. Marques: None. R. Rubinshtein: None. M.H. Al-Mallah: None. D. Andreini: None. G. Pontone: None. F. Cademartiri: None. E. Maffei: None. K. Kavitha Chinnaiyan: None. G. Raff: None. M. Hadamitzky: None. J. Hausleiter: None. G. Feuchtner: None. Y. Kim: None. P.A. Kaufmann: None. T.C. Villines: None. B. Chow: None. J.K. Min: None. L.J. Shaw: None.
- © 2016 by American Heart Association, Inc.