Differences of plaque burden measures on CCTA in younger men and women

Importance: The extent and severity of coronary artery disease (CAD) on coronary CT angiography (CCTA) is predictive of mortality, cardiovascular death, and non-fatal myocardial infarction in both men and women; however, associations of various measures of coronary plaque burden with prognosis in younger women and men has had little study. Objective: To compare prognostic significance of CAD plaque burden and distribution on CCTA in women and men <60. Design: 3813 consecutive patients (age: 49.4 ± 8.1 years, 36 % women) without CAD history who underwent CCTA (2007-2019) with clinical follow-up. Setting: Single academic medical center. Interventions: None. Main Outcomes: CCTA plaque burden was assessed by stenosis severity, segment involvement score (SIS), segment stenosis score (SSS), and coronary artery calcium (CAC) scores. Primary endpoint: all-cause mortality (ACM); secondary outcome: ACM or non-fatal MI (NFMI). Results: = 0.004). All plaque burden measures discriminated events in women better than men, with C-statistics for multivariable models ranging from 0.729-0.760 in women, compared to 0.674-0.690 in men. Findings were similar for ACM/NFMI. Conclusions: Prognostic significance of multiple measures of plaque burden identified by CCTA had greater prognostic impact in younger women, compared with younger men. Trial Registration: NA.