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. 2023 Aug 23;24(9):1201-1209.
doi: 10.1093/ehjci/jead072.

Prognostic value of combined coronary CT angiography and myocardial perfusion imaging in women and men

Iida Kujala  1 , Wail Nammas  1   2 , Teemu Maaniitty  1   3 , Iida Stenström  1   2 , Riku Klén  1 , Jeroen J Bax  2   4 , Juhani Knuuti  1   3 , Antti Saraste  1   2
Affiliations

Prognostic value of combined coronary CT angiography and myocardial perfusion imaging in women and men

Iida Kujala et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Combined anatomical and functional imaging enables detection of non-obstructive and obstructive coronary artery disease (CAD) as well as myocardial ischaemia. We evaluated sex differences in disease profile and outcomes after combined computed tomography angiography (CTA) and positron emission tomography (PET) perfusion imaging in patients with suspected obstructive CAD.

Methods and results: We retrospectively evaluated 1948 patients (59% women) referred for coronary CTA due to suspected CAD during the years 2008-2016. Patients with a suspected obstructive lesion on coronary CTA (n = 657) underwent 15O-water PET to assess stress myocardial blood flow (MBF). During a mean follow-up of 6.8 years, 182 adverse events (all-cause death, myocardial infarction, or unstable angina) occurred. Women had more often normal coronary arteries (42% vs. 22%, P < 0.001) and less often abnormal stress MBF (9% vs. 28%, P < 0.001) than men. The annual adverse event rate was lower in women vs. men (1.2% vs. 1.7%, P = 0.02). Both in women and men, coronary calcification, non-obstructive CAD, and abnormal stress MBF were independent predictors of events. Abnormal stress MBF was associated with 5.0- and 5.6-fold adverse event rates in women and men, respectively. There was no interaction between sex and coronary calcification, non-obstructive CAD, or abnormal stress MBF in terms of predicting adverse events.

Conclusion: Among patients evaluated for chronic chest pain, women have a lower prevalence of ischaemic CAD and a lower rate of adverse events. Combined coronary CTA and PET myocardial perfusion imaging predict outcomes equally in women and men.

Keywords: chronic chest pain; computed tomography angiography; coronary artery disease; hybrid imaging; positron emission tomography; sex.

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Conflict of interest statement

Conflict of interest: Dr. Knuuti received consultancy fees from GE Healthcare and speaker fees from GE Healthcare, Bayer, Lundbeck, Boehringer-Ingelheim, Pfizer, Siemens, and Merck, outside of the submitted work. Dr. Saraste received consultancy fees from Amgen and Astra Zeneca, Boehringer Ingelheim and Pfizer, and speaker fees from Abbott, Astra Zeneca, and Bayer outside of the submitted work. Dr. Bax received speaker fees from Abbot Vascular. The Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands has received unrestricted research grants from Bayer, Abbott Vascular, Medtronic, Biotronik, Boston Scientific, GE Healthcare, and Edwards Lifesciences. Other authors have no conflicts of interest to declare.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Flow chart of patient selection and classification according to imaging findings.
Figure 2
Figure 2
Graphs showing proportions of women and men with normal coronary arteries, non-obstructive CAD, obstructive CAD and normal sMBF, and obstructive CAD and abnormal sMBF.
Figure 3
Figure 3
Receiver operating characteristic (ROC) curves showing no difference in the performance of coronary artery calcium (CAC) score (P = 0.687) (A) or combined coronary CTA and 15O-water PET (P = 0.999) (B) in predicting composite end-point of death, non-fatal MI or UAP between men and women. Analyses were adjusted for age, hypertension, and symptom status (typical angina and dyspnoea).
Figure 4
Figure 4
Kaplan–Meier curves comparing the occurrence of death, non-fatal MI or UAP according to coronary artery calcium (CAC) score (A and C) or combined coronary CTA and 15O-water PET (B and D) in women (A and B) and men (C and D).
See this image and copyright information in PMC

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