TY - JOUR
T1 - AI-Quantitative CT Coronary Plaque Features Associate With a Higher Relative Risk in Women
T2 - CONFIRM2 Registry
AU - Feuchtner, Gudrun M.
AU - Lacaita, Pietro G.
AU - Bax, Jeroen J.
AU - Rodriguez, Fatima
AU - Nakanishi, Rine
AU - Pontone, Gianluca
AU - Mushtaq, Saima
AU - Buechel, Ronny R.
AU - Gräni, Christoph
AU - Patel, Amit R.
AU - Singulane, Cristiane C.
AU - Choi, Andrew D.
AU - Al-Mallah, Mouaz
AU - Andreini, Daniele
AU - Karlsberg, Ronald P.
AU - Cho, Geoffrey
AU - Rochitte, Carlos E.
AU - Alasnag, Mirvat
AU - Hamdan, Ashraf
AU - Cademartiri, Filippo
AU - Maffei, Erica
AU - Marques, Hugo
AU - Gonçalves Pereira, Pedro M.
AU - Gupta, Himanshu
AU - Hadamitzky, Martin
AU - Khalique, Omar
AU - Kalra, Dinesh
AU - Mills, James D.
AU - Nurmohamed, Nick S.
AU - Knaapen, Paul
AU - Budoff, Matthew
AU - Shaikh, Kashif
AU - Martin, Enrico
AU - German, David M.
AU - Ferencik, Maros
AU - Oehler, Andrew C.
AU - Deaño, Roderick
AU - Nagpal, Prashant
AU - Van Assen, Marly
AU - Nicola De Cecco, Carlo
AU - Foldyna, Borek
AU - Brendel, Jan Michael
AU - Cheng, Victor Y.
AU - Branch, Kelley
AU - Bittencourt, Marcio
AU - Bhatti, Sabha
AU - Polsani, Venkateshwar
AU - Wesbey, George
AU - Cardoso, Rhanderson
AU - Blankstein, Ron
AU - Delago, Augustin
AU - Pursnani, Amit
AU - Alsaid, Amro
AU - Bloom, Stephen
AU - Kamperidis, Vasileios
AU - Barbieri, Fabian
AU - Aquino, Melissa
AU - Danad, Ibrahim
AU - Rosendael, Alexander van
N1 - Publisher Copyright:
© 2025 The Authors.
PY - 2025/6/1
Y1 - 2025/6/1
N2 - 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-mm3 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 (Pinteraction<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; Pinteraction=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; Pinteraction=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.
AB - 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-mm3 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 (Pinteraction<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; Pinteraction=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; Pinteraction=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.
KW - artificial intelligence
KW - atherosclerosis
KW - computed tomography
KW - computed tomography angiography
KW - coronary artery disease
KW - women’s health
UR - https://www.scopus.com/pages/publications/105008466857
U2 - 10.1161/CIRCIMAGING.125.018235
DO - 10.1161/CIRCIMAGING.125.018235
M3 - Article
C2 - 40162910
AN - SCOPUS:105008466857
SN - 1941-9651
VL - 18
JO - Circulation: Cardiovascular Imaging
JF - Circulation: Cardiovascular Imaging
IS - 6
ER -
SDG 3 Good Health and Well-being