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Gender Differences in the Atherosclerosis Profile by Coronary CTA in Coronary Artery Calcium Score Zero Patients

Background: The coronary artery calcium score (CACS) is a powerful tool for cardiovascular risk stratification. Coronary computed tomography angiography (CTA) allows for a more distinct analysis of atherosclerosis. The aim of the study was to assess gender differences in the atherosclerosis profile...

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Autores principales: Senoner, Thomas, Plank, Fabian, Beyer, Christoph, Langer, Christian, Birkl, Katharina, Steinkohl, Fabian, Widmann, Gerlig, Barbieri, Fabian, Adukauskaite, Agne, Friedrich, Guy, Bauer, Axel, Dichtl, Wolfgang, Feuchtner, Gudrun M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000978/
https://www.ncbi.nlm.nih.gov/pubmed/33804095
http://dx.doi.org/10.3390/jcm10061220
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author Senoner, Thomas
Plank, Fabian
Beyer, Christoph
Langer, Christian
Birkl, Katharina
Steinkohl, Fabian
Widmann, Gerlig
Barbieri, Fabian
Adukauskaite, Agne
Friedrich, Guy
Bauer, Axel
Dichtl, Wolfgang
Feuchtner, Gudrun M.
author_facet Senoner, Thomas
Plank, Fabian
Beyer, Christoph
Langer, Christian
Birkl, Katharina
Steinkohl, Fabian
Widmann, Gerlig
Barbieri, Fabian
Adukauskaite, Agne
Friedrich, Guy
Bauer, Axel
Dichtl, Wolfgang
Feuchtner, Gudrun M.
author_sort Senoner, Thomas
collection PubMed
description Background: The coronary artery calcium score (CACS) is a powerful tool for cardiovascular risk stratification. Coronary computed tomography angiography (CTA) allows for a more distinct analysis of atherosclerosis. The aim of the study was to assess gender differences in the atherosclerosis profile of CTA in patients with a CACS of zero. Methods: A total of 1451 low- to intermediate-risk patients (53 ± 11 years; 51% females) with CACS <1.0 Agatston units (AU) who underwent CTA and CACS were included. Males and females were 1:1 propensity score-matched. CTA was evaluated for stenosis severity (Coronary Artery Disease – Reporting and Data System (CAD-RADS) 0–5: minimal <25%, mild 25–49%, moderate 50–69%, severe ≥70%), mixed-plaque burden (G-score), and high-risk plaque (HRP) criteria (low-attenuation plaque, spotty calcification, napkin-ring sign, and positive remodeling). All-cause mortality, cardiovascular mortality, and major cardiovascular events (MACEs) were collected. Results: Among the patients, 88.8% had a CACS of 0 and 11.2% had an ultralow CACS of 0.1–0.9 AU. More males than females (32.1% vs. 20.3%; p < 0.001) with a CACS of 0 had atherosclerosis, while, among those with an ultralow CACS, there was no difference (88% vs. 87.1%). Nonobstructive CAD (25.9% vs. 16.2%; p < 0.001), total plaque burden (2.2 vs. 1.4; p < 0.001), and HRP were found more often in males (p < 0.001). After a follow-up of mean 6.6 ± 4.2 years, all-cause mortality was higher in females (3.5% vs. 1.8%, p = 0.023). Cardiovascular mortality and MACEs were low (0.2% vs. 0%; p = 0.947 and 0.3% vs. 0.6%; p = 0.790) for males vs. females, respectively. Females were more often symptomatic for chest pain (70% vs. 61.6%; p = 0.004). (4) Conclusions: In patients with a CACS of 0, males had a higher prevalence of atherosclerosis, a higher noncalcified plaque burden, and more HRP criteria. Nonetheless, females had a worse long–term outcome and were more frequently symptomatic.
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spelling pubmed-80009782021-03-28 Gender Differences in the Atherosclerosis Profile by Coronary CTA in Coronary Artery Calcium Score Zero Patients Senoner, Thomas Plank, Fabian Beyer, Christoph Langer, Christian Birkl, Katharina Steinkohl, Fabian Widmann, Gerlig Barbieri, Fabian Adukauskaite, Agne Friedrich, Guy Bauer, Axel Dichtl, Wolfgang Feuchtner, Gudrun M. J Clin Med Article Background: The coronary artery calcium score (CACS) is a powerful tool for cardiovascular risk stratification. Coronary computed tomography angiography (CTA) allows for a more distinct analysis of atherosclerosis. The aim of the study was to assess gender differences in the atherosclerosis profile of CTA in patients with a CACS of zero. Methods: A total of 1451 low- to intermediate-risk patients (53 ± 11 years; 51% females) with CACS <1.0 Agatston units (AU) who underwent CTA and CACS were included. Males and females were 1:1 propensity score-matched. CTA was evaluated for stenosis severity (Coronary Artery Disease – Reporting and Data System (CAD-RADS) 0–5: minimal <25%, mild 25–49%, moderate 50–69%, severe ≥70%), mixed-plaque burden (G-score), and high-risk plaque (HRP) criteria (low-attenuation plaque, spotty calcification, napkin-ring sign, and positive remodeling). All-cause mortality, cardiovascular mortality, and major cardiovascular events (MACEs) were collected. Results: Among the patients, 88.8% had a CACS of 0 and 11.2% had an ultralow CACS of 0.1–0.9 AU. More males than females (32.1% vs. 20.3%; p < 0.001) with a CACS of 0 had atherosclerosis, while, among those with an ultralow CACS, there was no difference (88% vs. 87.1%). Nonobstructive CAD (25.9% vs. 16.2%; p < 0.001), total plaque burden (2.2 vs. 1.4; p < 0.001), and HRP were found more often in males (p < 0.001). After a follow-up of mean 6.6 ± 4.2 years, all-cause mortality was higher in females (3.5% vs. 1.8%, p = 0.023). Cardiovascular mortality and MACEs were low (0.2% vs. 0%; p = 0.947 and 0.3% vs. 0.6%; p = 0.790) for males vs. females, respectively. Females were more often symptomatic for chest pain (70% vs. 61.6%; p = 0.004). (4) Conclusions: In patients with a CACS of 0, males had a higher prevalence of atherosclerosis, a higher noncalcified plaque burden, and more HRP criteria. Nonetheless, females had a worse long–term outcome and were more frequently symptomatic. MDPI 2021-03-15 /pmc/articles/PMC8000978/ /pubmed/33804095 http://dx.doi.org/10.3390/jcm10061220 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Senoner, Thomas
Plank, Fabian
Beyer, Christoph
Langer, Christian
Birkl, Katharina
Steinkohl, Fabian
Widmann, Gerlig
Barbieri, Fabian
Adukauskaite, Agne
Friedrich, Guy
Bauer, Axel
Dichtl, Wolfgang
Feuchtner, Gudrun M.
Gender Differences in the Atherosclerosis Profile by Coronary CTA in Coronary Artery Calcium Score Zero Patients
title Gender Differences in the Atherosclerosis Profile by Coronary CTA in Coronary Artery Calcium Score Zero Patients
title_full Gender Differences in the Atherosclerosis Profile by Coronary CTA in Coronary Artery Calcium Score Zero Patients
title_fullStr Gender Differences in the Atherosclerosis Profile by Coronary CTA in Coronary Artery Calcium Score Zero Patients
title_full_unstemmed Gender Differences in the Atherosclerosis Profile by Coronary CTA in Coronary Artery Calcium Score Zero Patients
title_short Gender Differences in the Atherosclerosis Profile by Coronary CTA in Coronary Artery Calcium Score Zero Patients
title_sort gender differences in the atherosclerosis profile by coronary cta in coronary artery calcium score zero patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000978/
https://www.ncbi.nlm.nih.gov/pubmed/33804095
http://dx.doi.org/10.3390/jcm10061220
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