TCT-779 Different vessels, different risks? Sex-specific diagnostic performance of high-risk anatomic, physiologic parameters to predict acute coronary syndrome.

Abstract

Background: Sex differences exist in coronary vessel size and plaque composition. However, sex-specific prediction for acute coronary syndrome (ACS) is not well defined. Method(s): This study investigated the culprit, nonculprit lesions based on sex in ACS patients who underwent coronary computed tomography from 1 month to 3 years before the ACS event (EMERALD II, NCT03591328). The impact of sex on the diagnostic performance of anatomic and physiologic parameters considered significant for ACS (diameter stenosis, DS >=50%; plaque burden, PB >=70%; minimum lumen area, MLA <=4 mm2; high-risk plaque, HRP; DELTAFFRCT>=0.06) were analyzed. HRP included presence of >=2 features of low-attenuation plaque, positive remodeling, napkin ring sign, or spotty calcification. Result(s): In total, 619 lesions in women and 1,854 lesions in men were included. Women had smaller MLA (2.5 +/- 1.9 vs 2.7 +/- 2.3 mm2, P = 0.03), less noncalcified plaque volume (68.2 +/- 58.3 vs 74.8 +/- 66.4 mm3, P = 0.02), and less HRP (16.0% vs 21.7%, P = 0.003). In lesions with significant risk features, both sexes showed similar proportion of culprits (Figure 1). The sensitivity and specificity of each feature were similar among sexes and diagnostic accuracy reached 82.1% vs 79.9% for DS, 77.4% vs 77.8% for DELTAFFRCT, and 79.7% vs 77.6% for HRP (women vs men) (Figure 2). The addition of HRP and DELTAFFRCT to DS increased global chi-square value (all P < 0.05) for both sexes. [Formula presented] Conclusion(s): Although women and men showed different lesion characteristics, the diagnostic performance of significant features in predicting ACS were similar, with incremental prognostic value of HRP and DELTAFFRCT over DS in both sexes. Categories: OTHER: Women's Health Issues.Copyright © 2024