Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction.
Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction.
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性别特定的计算机断层扫描冠状斑块和心肌梗塞的风险。
DOI：
10.1016/j.jcmg.2021.03.004
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Dey D
中科院分区：
文献类型：
--
作者：
Williams MC;Kwiecinski J;Doris M;McElhinney P;D'Souza MS;Cadet S;Adamson PD;Moss AJ;Alam S;Hunter A;Shah ASV;Mills NL;Pawade T;Wang C;Weir-McCall JR;Bonnici-Mallia M;Murrills C;Roditi G;van Beek EJR;Shaw LJ;Nicol ED;Berman DS;Slomka PJ;Newby DE;Dweck MR;Dey D
本研究旨在探讨冠状动脉ct血管造影对冠状动脉斑块的评估是否可以解释男性和女性胸痛预后的差异。冠状动脉疾病存在重要的性别差异。与男性相比，出现胸痛的女性有不同的风险因素、症状、冠状动脉疾病的患病率和预后。在一项多中心随机对照试验中，我们探讨了狭窄、不良斑块特征（正重构、低衰减斑块、点状钙化或餐巾环征）的性别差异，以及总、钙化、非钙化和低衰减斑块负担的定量评估。在接受冠状动脉ct血管造影的1769名参与者中，772名（43%）为女性。女性有正常冠状动脉的可能性更大，有不良斑块特征的可能性更小（p < 0.001）。他们的总斑块、钙化斑块、非钙化斑块和低衰减斑块负担均较低（均p < 0.001），低衰减斑块负担的可能性较低（分别为41%和59%，p < 0.001）。在中位4.7年的随访中，11名女性（1.4%）和30名男性（3%）发生心肌梗死（MI）。在心肌梗死患者中，女性的总、非钙化和低衰减斑块负担与男性相似，但男性的钙化斑块负担更高。低衰减斑块负荷预测心肌梗死（风险比：1.60；95%可信区间：1.10 ~ 2.34;p = 0.015），与钙评分、阻塞性疾病、心血管风险评分和性别无关。与男性相比，出现稳定胸痛的女性所有亚型的动脉粥样硬化斑块较少，随后发生心肌梗死的风险也较低。然而，定量低衰减斑块与男性一样，是女性随后发生心肌梗死的强有力预测指标。（苏格兰心脏计算机断层扫描试验[SCOT-HEART]； NCT01149590）。
This study was designed to investigate whether coronary computed tomography angiography assessments of coronary plaque might explain differences in the prognosis of men and women presenting with chest pain. Important sex differences exist in coronary artery disease. Women presenting with chest pain have different risk factors, symptoms, prevalence of coronary artery disease and prognosis compared to men. Within a multicenter randomized controlled trial, we explored sex differences in stenosis, adverse plaque characteristics (positive remodeling, low-attenuation plaque, spotty calcification, or napkin ring sign) and quantitative assessment of total, calcified, noncalcified and low-attenuation plaque burden. Of the 1,769 participants who underwent coronary computed tomography angiography, 772 (43%) were female. Women were more likely to have normal coronary arteries and less likely to have adverse plaque characteristics (p < 0.001 for all). They had lower total, calcified, noncalcified, and low-attenuation plaque burdens (p < 0.001 for all) and were less likely to have a low-attenuation plaque burden >4% (41% vs. 59%; p < 0.001). Over a median follow-up of 4.7 years, myocardial infarction (MI) occurred in 11 women (1.4%) and 30 men (3%). In those who had MI, women had similar total, noncalcified, and low-attenuation plaque burdens as men, but men had higher calcified plaque burden. Low-attenuation plaque burden predicted MI (hazard ratio: 1.60; 95% confidence interval: 1.10 to 2.34; p = 0.015), independent of calcium score, obstructive disease, cardiovascular risk score, and sex. Women presenting with stable chest pain have less atherosclerotic plaque of all subtypes compared to men and a lower risk of subsequent MI. However, quantitative low-attenuation plaque is as strong a predictor of subsequent MI in women as in men. (Scottish Computed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).
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影响因子：
6.2
作者：
Conte, Edoardo;Dwivedi, Aeshita;Andreini, Daniele
通讯作者：
Andreini, Daniele
影响因子：
7.5
作者：
Kataoka, Yu;Puri, Rishi;Nicholls, Stephen J.
通讯作者：
Nicholls, Stephen J.
影响因子：
39.3
作者：
Shaw, Leslee J.;Min, James K.;Blaha, Michael J.
通讯作者：
Blaha, Michael J.
影响因子：
168.9
作者：
Newby, David;Williams, Michelle;Steedman, Tracey
通讯作者：
Steedman, Tracey
DOI：
10.1016/0735-1097(90)90282-t
发表时间：
1990-03-15
影响因子：
24
作者：
AGATSTON, AS;JANOWITZ, WR;DETRANO, R
通讯作者：
DETRANO, R