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. 2024 Nov;51(13):3934-3943.
doi: 10.1007/s00259-024-06810-x. Epub 2024 Jun 27.

Sex differences in coronary atherosclerotic plaque activity using 18F-sodium fluoride positron emission tomography

Jacek Kwiecinski  1 , Kang-Ling Wang  2 , Evangelos Tzolos  2 , Alastair Moss  2 , Marwa Daghem  2 , Philip D Adamson  3 , Damini Dey  4 , Patrycja Molek-Dziadosz  2 , Dana Dawson  5 , Parthiban Arumugam  6 , Nikant Sabharwal  7 , John P Greenwood  8 , John N Townend  9 , Patrick A Calvert  10 , James Hf Rudd  11 , Daniel Berman  4 , Johan W Verjans  12   13 , Michelle C Williams  2 , Piotr Slomka  4 , Marc R Dweck  2 , David E Newby  2
Affiliations

Sex differences in coronary atherosclerotic plaque activity using 18F-sodium fluoride positron emission tomography

Jacek Kwiecinski et al. Eur J Nucl Med Mol Imaging. 2024 Nov.

Abstract

Introduction: There are sex differences in the extent, severity, and outcomes of coronary artery disease. We aimed to assess the influence of sex on coronary atherosclerotic plaque activity measured using coronary 18F-sodium fluoride (18F-NaF) positron emission tomography (PET), and to determine whether 18F-NaF PET has prognostic value in both women and men.

Methods: In a post-hoc analysis of observational cohort studies of patients with coronary atherosclerosis who had undergone 18F-NaF PET CT angiography, we compared the coronary microcalcification activity (CMA) in women and men.

Results: Baseline 18F-NaF PET CT angiography was available in 999 participants (151 (15%) women) with 4282 patient-years of follow-up. Compared to men, women had lower coronary calcium scores (116 [interquartile range, 27-434] versus 205 [51-571] Agatston units; p = 0.002) and CMA values (0.0 [0.0-1.12] versus 0.53 [0.0-2.54], p = 0.01). Following matching for plaque burden by coronary calcium scores and clinical comorbidities, there was no sex-related difference in CMA values (0.0 [0.0-1.12] versus 0.0 [0.0-1.23], p = 0.21) and similar proportions of women and men had no 18F-NaF uptake (53.0% (n = 80) and 48.3% (n = 73); p = 0.42), or CMA values > 1.56 (21.8% (n = 33) and 21.8% (n = 33); p = 1.00). Over a median follow-up of 4.5 [4.0-6.0] years, myocardial infarction occurred in 6.6% of women (n = 10) and 7.8% of men (n = 66). Coronary microcalcification activity greater than 0 was associated with a similarly increased risk of myocardial infarction in both women (HR: 3.83; 95% CI:1.10-18.49; p = 0.04) and men (HR: 5.29; 95% CI:2.28-12.28; p < 0.001).

Conclusion: Although men present with more coronary atherosclerotic plaque than women, increased plaque activity is a strong predictor of future myocardial infarction regardless of sex.

Keywords: 18F-NaF PET; Coronary artery disease; Gender; Myocardial infarction; Sex.

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Conflict of interest statement

Compliance with Ethical Standards

The authors have no relevant financial or non-financial interests to disclose.

The studies were conducted with the approval of the Scottish Research Ethics Committee (14/SS/0089, 15/SS/0203 and 15-SS-0059), in accordance with the Declaration of Helsinki, and with the written informed consent of each participant.

Figures

Figure 1.
Figure 1.. Sex differences in coronary artery disease activity (Graphical Abstract).
While women have lower disease burden and plaque activity on 18F-sodium fluoride positron emission tomography than men, the coronary microcalcification activity is a strong predictor of subsequent myocardial infarction regardless of sex. median [interquartile range]; AU, Agatston Units; CMA, coronary microcalcification activity
Figure 2.
Figure 2.. Plaque burden and activity in men and women.
Men (n=848) have higher coronary calcium scores and coronary microcalcification activity than women (n=151). However, when patients were matched according to disease burden, there was no difference in coronary 18F-sodium fluoride uptake in men (n=151) and women (n=151). AU – Agatston units
Figure 3.
Figure 3.. Coronary microcalcification activity and myocardial infarction in women and men.
Cumulative incidence plots of myocardial infarction in women and men showing the difference in events between those with (green) and without (blue) a coronary microcalcification activity above 0. CI, confidence interval; HR, hazard ratio
Figure 4.
Figure 4.. Case examples of patients who experienced a myocardial infarction during follow-up.
Despite sex-related discrepancies in disease burden there was no difference in the coronary microcalcification activity between women and men who experienced an event during follow-up. CMA, coronary microcalcification activity; NSTEMI, non-ST elevation myocardial infarction; STEMI, ST elevation myocardial infarction
See this image and copyright information in PMC

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