AI-Quantitative CT Coronary Plaque Features Associate With a Higher Relative Risk in Women: CONFIRM2 Registry
Circulation Cardiovascular Imaging, vol. 18, pp. e018235
Abstract
BACKGROUND: 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 computed tomography (AI-QCT) and the associated risk of major adverse cardiovascular events (MACEs). METHODS: Global multicenter registry including symptomatic patients with suspicion of coronary artery disease referred for coronary computed tomography angiography. AI-QCT analyzed 16 coronary artery disease features. The primary end point was MACE defined as death, myocardial infarction, late revascularization, cerebrovascular events, unstable angina, and congestive heart failure. RESULTS: 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, noncalcified plaque, calcified plaque, and percentage atheroma volume were significantly higher in men ( P <0.001), and high-risk plaques were more prevalent (9.2% versus 2.5%; P <0.0001). Independent of age and cardiovascular risk factors, the AI-QCT-derived features of total plaque volume, noncalcified plaque, calcified plaque, and percentage atheroma volume conferred a higher relative risk of MACE in women than men. For every 50-mm 3 increase in total plaque volume, relative risk increased by 17.7% (95% CI, 1.12–1.24) in women versus 5.3% (95% CI, 1.03–1.07) in men ( P interaction <0.001); for noncalcified plaque, relative risk increased by 27.1% (95% CI, 1.17–1.38) versus 11.6% (95% CI, 1.08–1.15; P interaction =0.0015); and for calcified plaque, relative risk increased by 22.9% (95% CI, 1.14–1.33) versus 5.4% (95% CI, 1.01–1.10; P interaction =0.0012), respectively. Similarly, for percentage atheroma volume, the risk was higher in women. The findings remained unchanged when restricted to a secondary composite end point (death and myocardial infarction). CONCLUSIONS: The AI-QCT plaque features, total plaque volume, noncalcified plaque, calcified plaque, and percentage atheroma volume, conferred a higher relative MACE risk in women and may prompt more aggressive antiatherosclerotic therapy and reinforced preventive interventions. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04279496.
Authors 55
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Gudrun Maria Feuchtner corresponding
Innsbruck Medical University · Universität Innsbruck
Affiliation as printed
Department of Radiology, Medical University of Innsbruck, Austria (G.M.F., P.G.L.)
Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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Innsbruck Medical University · Universität Innsbruck
Affiliation as printed
Department of Radiology, Medical University of Innsbruck, Austria (G.M.F., P.G.L.)
Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Center, the Netherlands (J.J.B., A.R.)
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Stanford Medicine · Stanford Cardiovascular Institute · Stanford University
Affiliation as printed
Division of Cardiovascular Medicine, Stanford University School of Medicine, Paolo Alto, CA (F.R.)
Stanford University School of Medicine, Cardiovascular Medicine, Paolo Alto, CA
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Affiliation as printed
Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan (R.N.)
Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
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University of Milan · Centro Cardiologico Monzino
Affiliation as printed
Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy (G.P.)
Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy (G.P.)
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
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Affiliation as printed
Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy (S.M.)
Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
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University of Zurich · University Hospital Zurich
Affiliation as printed
Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Switzerland (R.R.B.)
Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Zurich, Switzerland
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University of Bern · University Hospital of Bern
Affiliation as printed
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (C.G.)
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Affiliation as printed
Division of Cardiovascular Medicine, University of Virginia, Charlottesville (A.R.P., C.C.S.)
Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA
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Affiliation as printed
Division of Cardiovascular Medicine, University of Virginia, Charlottesville (A.R.P., C.C.S.)
Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA
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Affiliation as printed
Department of Cardiology and Radiology, George Washington University, Washington, DC (A.D.C., )
Department of Cardiology and Radiology, George Washington University, Washington, DC
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Affiliation as printed
Department of Cardiology, Houston Methodist, TX (M.A.-M.,.)
Department of Cardiology, Houston Methodist, Houston, TX
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University of Milan · IRCCS Ospedale Galeazzi - Sant'Ambrogio
Affiliation as printed
Division of University Cardiology, IRCCS Galeazzi Sant’Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Italy (D.A.)
Division of University Cardiology, IRCCS Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Italy
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University of California, Los Angeles · Cedars-Sinai Smidt Heart Institute · Cardiovascular Research Foundation
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Cardiovascular Research Foundation of Southern California, Cedars-Sinai Heart, David Geffen School of Medicine, University of California Los Angeles (R.P.K., G.C.)
Cardiovascular Research Foundation of Southern California, Beverly Hills, CA
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University of California, Los Angeles · Cedars-Sinai Smidt Heart Institute
Affiliation as printed
Cardiovascular Research Foundation of Southern California, Cedars-Sinai Heart, David Geffen School of Medicine, University of California Los Angeles (R.P.K., G.C.)
Cedars-Sinai Heart, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Universidade de São Paulo · Instituto do Coração - HCFMUSP
Affiliation as printed
Heart Institute, InCor, University of São Paulo Medical School, Brazil (C.E.R.)
Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
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King Fahd Armed Forces Hospital
Affiliation as printed
Cardiac Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M. Alasnag)
Cardiac Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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Tel Aviv University · Rabin Medical Center
Affiliation as printed
Department of Cardiology, Rabin Medical Center, Petah Tikva and Tel Aviv University, Israel (A.H.)
Department of Cardiology, Rabin Medical Center, Petah Tikva & Tel-Aviv University, Tel-Aviv, Israel, ISRAEL
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Affiliation as printed
IRCCS SYNLAB SDN, Naples, Italy (F.C.)
IRCCS SYNLAB SDN, Naples, Italy
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Affiliation as printed
Department of Radiology, Istituto di Ricovero e Cura a Carattere (IRCCS) SYNLAB SDN, Naples, Italy (E. Maffei)
Department of Radiology, Istituto di Ricerca e Cura a Carattere Scientifico SYNLAB SDN, 80131 Naples, Italy
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Affiliation as printed
UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal (H.M., P.M.G.F)
UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
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Affiliation as printed
Cardiac Imaging, Heart and Vascular Institute, Valley Health System, Paramus, NJ (H.G.)
Cardiac Imaging, Heart and Vascular Institute, Valley Health System, Paramus, NJ
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Affiliation as printed
Department of Radiology and Nuclear Medicine, German Heart Center Munich, Germany (M.H.)
Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
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Affiliation as printed
Division of Cardiovascular Imaging, St. Francis Hospital and Heart Center, Roslyn, NY (O.K.)
Division of Cardiovascular Imaging, St. Francis Hospital and Heart Center, Roslyn, NY
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Affiliation as printed
Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, KY (D.K.)
Division of Cardiology, Department of Medicine, University of Louisville School of Medicine, Louisville, KY
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
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Department of Cardiology and Department of Vascular Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (N.S.N.)
Department of Cardiology and Department of Vascular Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
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Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (P.K.)
Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Affiliation as printed
The Lundquist Institute, Torrance, CA (M. Budoff)
The Lundquist Institute, Torrance, CA
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University of Tennessee Medical Center
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University of Tennessee Medical Center, Knoxville (K.S.)
University of Tennessee Medical Center, Knoxville, TN
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Oregon Health & Science University
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Knight Cardiovascular Institute, Oregon Health & Science University, Portland (D.M.G., M.F.)
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
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Oregon Health & Science University
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Knight Cardiovascular Institute, Oregon Health & Science University, Portland (D.M.G., M.F.)
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
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Allegheny Health Network Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA (A.C.O.)
Allegheny Health Network Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA
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University of Wisconsin–Madison
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Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (R.D.)
Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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University of Wisconsin–Madison
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Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (P.N.)
Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Affiliation as printed
Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA (M.V.A., C.N.D.C.)
Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
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Affiliation as printed
Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA (M.V.A., C.N.D.C.)
Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
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Harvard University · Massachusetts General Hospital
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Department of Radiology, Cardiovascular Imaging and Research Center, Massachusetts General Hospital and Harvard Medical School, Boston (B.F., J.M.B.)
Department of Radiology, Cardiovascular Imaging and Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Harvard University · Massachusetts General Hospital
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Department of Radiology, Cardiovascular Imaging and Research Center, Massachusetts General Hospital and Harvard Medical School, Boston (B.F., J.M.B.)
Department of Radiology, Cardiovascular Imaging and Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Affiliation as printed
Minneapolis Heart Institute, MN (V.Y.C.)
Minneapolis Heart Institute, Minneapolis, MN
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Affiliation as printed
Division of Cardiology, Cardiovascular Clinical Trials, University of Washington, Seattle (K.B.)
Division of Cardiology, Cardiovascular Clinical Trials, University of Washington, Seattle, WA
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University of Pittsburgh Medical Center
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Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (M. Bittencourt)
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
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National Institute of Cardiovascular Diseases
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National Institute of Cardiovascular Diseases, Karachi, Pakistan (S. Bhatti)
National Institute of Cardiovascular Diseases, Karachi, Pakistan, PAKISTAN
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Affiliation as printed
Piedmont Heart Institute, Atlanta, GA (V.P.)
Piedmont Heart Institute, Atlanta, GA
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Affiliation as printed
Department of Cardiovascular Computed Tomography, Scripps Clinic, La Jolla, CA (G.W.)
Department of Cardiovascular Computed Tomography, Scripps Clinic, La Jolla, CA
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Affiliation as printed
Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (R.C., R.B.)
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
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Affiliation as printed
Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (R.C., R.B.)
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
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Mount Auburn Hospital · Harvard University
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Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA (A.D.)
Medical Data Research Collaborative, United Kingdom (A.D.)
Medical Data Research Collaborative, UK; Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
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Endeavor Health · University of Chicago
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Cardiology, Endeavor NorthShore Cardiovascular Institute, Evanston, IL (A.P.)
Pritzker School of Medicine, University of Chicago, IL (A.P.)
Cardiology, Endeavor NorthShore Cardiovascular Institute, Evanston, IL; University of Chicago, Pritzker School of Medicine, Chicago, IL
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Affiliation as printed
Department of Cardiac Imaging, Baylor Scott & White The Heart Hospital Plano, TX (A.A.)
Department of Cardiac Imaging, Baylor Scott and White The Heart Hospital Plano, Plano, TX
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Aristotle University of Thessaloniki
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1st Cardiology Department, Medical School, Aristotle University of Thessaloniki, Greece (V.K.)
1st Cardiology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Deutsches Herzzentrum der Charité
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Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany (F.B.)
Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
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Affiliation as printed
Cleerly Health, Denver, CO (M. Aquino)
Cleerly Health, Denver, CO
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Radboud University Nijmegen · Radboud University Medical Center
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Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (I.D.)
Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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Leiden University Medical Center
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Department of Cardiology, Leiden University Medical Center, the Netherlands (J.J.B., A.R.)
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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