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 coronary computed tomography (AI-QCT) and the associated risk of major adverse cardiovascular events (MACE). Methods: Global multicenter registry (CONFIRM2) including symptomatic patients with suspicion of CAD referred for coronary CTA. AI-QCT analyzed 16 CAD features. Primary endpoint 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 (TPV), noncalcified plaque (NCP), calcified plaque (CP) and percentage atheroma volume (PAV) were significantly higher in men (p<0.001), and high-risk plaque (HRP) was more prevalent (9.2% vs 2.5%, p<0.0001). Independent of age and cardiovascular risk factors, the AI-QCT derived features of TPV, NCP, CP, and PAV conferred a higher relative risk of MACE in women than men. For every 50mm3 increase in TPV, relative risk increased by 17.7% (95% CI 1.12-1.24) in women vs 5.3% (95% CI 1.03-1.07) in men (p-interaction<0.001), for NCP relative risk increased by 27.1% (95% CI 1.17-1.38) vs 11.6% (95% CI 1.08-1.15) (p-interaction = 0.0015), and for CP, by 22.9% (95% CI 1.14-1.33) vs 5.4% (95% CI 1.01-1.10) (p-interaction = 0.0012), respectively. Similarly, for PAV the risk was higher in women. The findings remained unchanged when restricted to a secondary composite endpoint (death and myocardial infarction). Conclusions: The AI-QCT plaque features TPV, NCP, CP and PAV conferred a higher relative MACE risk in women and may prompt more aggressive anti-atherosclerotic therapy and reinforced preventive interventions.
AI-quantitative CT coronary plaque features associate with a higher relative risk in women: CONFIRM2-Registry / G.M. Feuchtner, P.G. Lacaita, J.J. Bax, F. Rodriguez, R. Nakanishi, G. Pontone, S. Mushtaq, R.R. Buechel, C. Gräni, A.R. Patel, C.C. Singulane, A.D. Choi, M. Al-Mallah, D. Andreini, R.P. Karlsberg, G.W. Cho, C.E. Rochitte, M. Alasnag, A. Hamdan, F. Cademartiri, E. Maffei, H. Marques, P.M. Gonçalves Pereira, H. Gupta, M. Hadamitzky, O. Khalique, D. Kalra, J.D. Mills, N.S. Nurmohamed, P. Knaapen, M. Budoff, K. Shaikh, E. Martin, D.M. German, M. Ferencik, A.C. Oehler, R. Deaño, P. Nagpal, M. Van Assen, C.N. De Cecco, B. Foldyna, J.M. Brendel, V.Y. Cheng, K. Branch, M. Bittencourt, S. Bhatti, V. Polsani Md, G. Wesbey, R. Cardoso, R. Blankstein, A. Delago, A. Pursnani, A. Alsaid, S. Bloom, V. Kamperidis, F. Barbieri, M. Aquino, I. Danad, A. Van Rosendael. - In: CIRCULATION. CARDIOVASCULAR IMAGING. - ISSN 1941-9651. - 18:6(2025 Jun), pp. 463-475. [10.1161/CIRCIMAGING.125.018235]
AI-quantitative CT coronary plaque features associate with a higher relative risk in women: CONFIRM2-Registry
G. Pontone;D. Andreini;
2025
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 coronary computed tomography (AI-QCT) and the associated risk of major adverse cardiovascular events (MACE). Methods: Global multicenter registry (CONFIRM2) including symptomatic patients with suspicion of CAD referred for coronary CTA. AI-QCT analyzed 16 CAD features. Primary endpoint 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 (TPV), noncalcified plaque (NCP), calcified plaque (CP) and percentage atheroma volume (PAV) were significantly higher in men (p<0.001), and high-risk plaque (HRP) was more prevalent (9.2% vs 2.5%, p<0.0001). Independent of age and cardiovascular risk factors, the AI-QCT derived features of TPV, NCP, CP, and PAV conferred a higher relative risk of MACE in women than men. For every 50mm3 increase in TPV, relative risk increased by 17.7% (95% CI 1.12-1.24) in women vs 5.3% (95% CI 1.03-1.07) in men (p-interaction<0.001), for NCP relative risk increased by 27.1% (95% CI 1.17-1.38) vs 11.6% (95% CI 1.08-1.15) (p-interaction = 0.0015), and for CP, by 22.9% (95% CI 1.14-1.33) vs 5.4% (95% CI 1.01-1.10) (p-interaction = 0.0012), respectively. Similarly, for PAV the risk was higher in women. The findings remained unchanged when restricted to a secondary composite endpoint (death and myocardial infarction). Conclusions: The AI-QCT plaque features TPV, NCP, CP and PAV conferred a higher relative MACE risk in women and may prompt more aggressive anti-atherosclerotic therapy and reinforced preventive interventions.
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