Risk in Women Emerges at Lower Coronary Plaque Burden Than in Men: PROMISE Trial.

IF 9.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2026-03-01 Epub Date: 2026-02-23 DOI:10.1161/CIRCIMAGING.125.019011

Jan M Brendel, Thomas Mayrhofer, Júlia Karády, Márton Kolossváry, Nóra M Kerkovits, Isabel L Langenbach, Matthias Jung, Michelle D Kelsey, Marcel C Langenbach, Neha Pagidipati, Svati H Shah, Michael T Lu, Maros Ferencik, Pamela S Douglas, Borek Foldyna

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引用次数: 0

Abstract

Background: Quantitative coronary plaque measures differ in prognostic value between women and men. It remains unclear whether cardiovascular risk increases proportionally with plaque extent in both sexes. We aimed to compare cardiovascular risk trajectories across quantitative coronary plaque measures in women and men with stable chest pain.

Methods: We analyzed data from the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) coronary computed tomography angiography arm, quantifying total coronary plaque volume and burden (plaque burden [PB]; % vessel volume), including calcified, noncalcified, and low-attenuation components. Associations with major adverse cardiovascular events (death, myocardial infarction, or unstable angina hospitalization) were assessed using sex-stratified spline Cox models over a median 26 months (interquartile range, 18-34).

Results: Among 4267 patients (mean age, 60.4±8.2; 2199 women), plaque was less frequent in women (55% versus 75%; P<0.001), with lower total plaque volume but similar total PB and incident major adverse cardiovascular events (2.3% versus 3.4%). Major adverse cardiovascular event risk became elevated at lower PB in women than in men: for total PB, hazard ratio crossed 1.0 at 20% in women versus 28% in men, reaching hazard ratio 1.5 at 32% in women versus 42% in men, respectively. Noncalcified PB showed a similar pattern, crossing hazard ratio 1.0 at 7% in women versus 9% in men; hazard ratio 1.5 at 13% in women versus 20% in men. Findings were similar after adjustment for atherosclerotic cardiovascular disease risk score.

Conclusions: In women, major adverse cardiovascular events appeared to emerge at a lower PB, and to rise more sharply. Findings support sex-specific interpretation of coronary computed tomography angiography-derived plaque metrics for timely intervention in women.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01174550.

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女性冠状动脉斑块负担低于男性的风险：PROMISE试验

背景：定量冠状动脉斑块测量在男性和女性之间的预后价值不同。目前尚不清楚男女患心血管疾病的风险是否随斑块的扩大而增加。我们的目的是比较稳定胸痛的女性和男性在定量冠状动脉斑块测量中的心血管风险轨迹。方法：我们分析了来自PROMISE（前瞻性胸痛评估多中心成像研究）冠状动脉计算机断层造影组的数据，量化冠状动脉斑块总体积和负荷（斑块负荷[PB]；血管体积百分比），包括钙化、非钙化和低衰减成分。主要不良心血管事件（死亡、心肌梗死或不稳定心绞痛住院）的相关性采用性别分层样条Cox模型进行评估，中位时间为26个月（四分位数范围18-34）。结果：在4267例患者（平均年龄，60.4±8.2；2199名女性）中，斑块在女性中较少发生（55%对75%）。结论：在女性中，主要不良心血管事件似乎在较低的PB时出现，并且上升更快。研究结果支持冠状动脉ct血管造影衍生斑块指标对女性及时干预的性别特异性解释。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT01174550。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.