Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Women versus Men: Long-Term Outcomes from the CONFIRM Registry Pubblico
Xie, Joe X. (2017)
Published
Abstract
Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Women versus Men: Long-Term Outcomes from the CONFIRM Registry
By Joe X. Xie
Background: Patients with obstructive (≥50% stenosis) left main (LM) coronary artery disease (CAD) are at high risk for future adverse events; prior studies have also documented worse outcomes among women than men with severe multivessel/LM CAD. However, clinical outcomes associated with nonobstructive (1-49% stenosis) LM CAD have not been previously examined and as a result, the optimal management strategy of nonobstructive left main disease is not clear.
Objective: To assess the prognostic significance of nonobstructive left main (LM) coronary artery disease (CAD) and examine sex differences in subjects with suspected underlying CAD.
Methods: In the long-term COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, patients underwent elective coronary computed tomographic angiography (CCTA) for suspected CAD and were followed for 5 years. After excluding obstructive LM CAD, 5,166 patients were categorized as having normal LM or nonobstructive LM. Kaplan-Meier and multivariable Cox proportional hazards models, adjusted for baseline demographics, CAD risk factors, and obstructive CAD burden in other vessels, were used to estimate the composite risk of death, myocardial infarction (MI), or revascularization in women and men by LM status.
Results: Non-obstructive LM was detected in 18% of patients. The composite incidence of death, myocardial infarction, or revascularization was higher among patients with nonobstructive LM than normal LM, 27.3% versus 17.2% (p<0.0001). A significant interaction existed between sex and LM status for the composite outcome (p =0.001). In multivariable Cox regression, the presence of nonobstructive LM plaque increased the risk for the composite outcome in women (HRadj 1.63, [1.26-2.10], p<0.001), but not in men (HRadj 0.99 [0.82-1.19], p=0.879) (padj-for-interaction=0.002). Among those with nonobstructive LM CAD, women had a nearly 80% higher risk for events than men with nonobstructive LM CAD (HRadj 1.78 [1.31-2.25], p=0.017).
Conclusion: Nonobstructive LM CAD was frequently detected on CCTA and significantly associated with adverse events. While in men the association was confounded by comorbid CAD risk factors and co-occurring CAD burden, in women, nonobstructive LM remained associated with downstream events even after multivariable adjustment. Recognizing the prognostic significance of nonobstructive LM plaque in women may augment risk stratification efforts.
Table of Contents
TABLE OF CONTENTS
BACKGROUND…………………………………………………………………..…...1
METHODS………………………………………………………………………..……..4
RESULTS…………………………………………………………………………..…….9
DISCUSSION…………………………………………………………………….…...12
REFERENCES……………………………………….…………………………….…..17
FIGURES………………………………………………………………………….……..20
TABLES………………………………………………………………….………...….…24
APPENDIX…………………………………………………………………….…..….…27
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