Gabara Lavinia, Hinton Jonathan, Kira Mohamed, Shambrook James, Abbas Ausami, Wilding Sam, Leipsic Jonathon A, Douglas Pamela S, Curzen Nick
Coronary Research Group University Hospital Southampton NHS FT Southampton United Kingdom.
Faculty of Medicine University of Southampton United Kingdom.
J Am Heart Assoc. 2025 Feb 4;14(3):e029950. doi: 10.1161/JAHA.123.029950. Epub 2025 Feb 3.
The impact of sex-related differences in coronary atheroma and flow impairment severity on clinical events and costs remains unclear.
This is a secondary analysis of patients with stable coronary artery disease who underwent both coronary computed tomography angiography and fractional flow reserve derived from computed tomography as part of the FORECAST (Fractional Flow Reserve Derived From Computed Tomography Coronary Angiography in the Assessment and Management of Stable Chest Pain) trial, investigating (1) the relationship between coronary stenosis severity on coronary computed tomography angiography and fractional flow reserve derived from computed tomography FFR by sex and (2) the association with revascularization, resource usage, and adverse clinical events. A total of 212 patients (64 female participants [32.1%]) and 1245 vessels were included. There was no significant sex difference in the frequencies of significant coronary artery disease (38.2% of women versus 51.3% of men; =0.073), but female participants had significantly less coronary flow impairment, according to the presence of at least 1 fractional flow reserve derived from computed tomography≤0.8 (47.0% versus 71.5%; =0.008). Female subjects underwent fewer revascularization procedures (23.5% versus 42.3%; =0.014), less coronary artery bypass graft surgery (2.9% versus 13.1%; =0.025) and were less likely to be on statin treatment (72.0% versus 84.7%; =0.022) by 9-month follow-up. This resulted in lower overall health care costs for female participants compared with male counterparts (median total cost, £1276 versus £2051; =0.014). In multivariable Cox analysis the presence of significant coronary artery disease (hazard ratio [HR], 2.91; 95% CI, 1.30-6.51) and having a positive fractional flow reserve derived from computed tomography (HR, 4.11; 95% CI, 1.15-14.69) were independent predictors of major adverse cardiovascular events at 9 months, whereas sex was not statistically significant (=0.13).
There are significant sex differences in the anatomico-functional assessment of coronary artery disease leading to differences in clinical management, costs, and adverse events.
冠状动脉粥样硬化和血流受损严重程度的性别差异对临床事件和成本的影响尚不清楚。
这是一项对稳定型冠状动脉疾病患者的二次分析，这些患者作为FORECAST（计算机断层扫描冠状动脉造影评估和管理稳定胸痛中计算机断层扫描衍生的血流储备分数）试验的一部分，同时接受了冠状动脉计算机断层扫描血管造影和计算机断层扫描衍生的血流储备分数检查，研究（1）按性别划分的冠状动脉计算机断层扫描血管造影上的冠状动脉狭窄严重程度与计算机断层扫描衍生的血流储备分数（FFR）之间的关系，以及（2）与血运重建、资源使用和不良临床事件的关联。共纳入212例患者（64名女性参与者[32.1%]）和1245支血管。在显著冠状动脉疾病的发生率方面没有显著的性别差异（女性为38.2%，男性为51.3%；P = 0.073），但根据至少有1个计算机断层扫描衍生的血流储备分数≤0.8的情况，女性参与者的冠状动脉血流受损明显较少（47.0%对71.5%；P = 0.008）。到9个月随访时，女性接受血运重建手术的比例较低（23.5%对42.3%；P = 0.014），冠状动脉旁路移植手术较少（2.9%对13.1%；P = 0.025），服用他汀类药物治疗的可能性也较小（72.0%对84.7%；P = 0.022）。这导致女性参与者的总体医疗保健成本低于男性（中位总成本，1276英镑对2051英镑；P = 0.014）。在多变量Cox分析中，显著冠状动脉疾病的存在（风险比[HR]，2.91；95%置信区间，1.30 - 6.51）和计算机断层扫描衍生的血流储备分数为阳性（HR，4.11；95%置信区间，1.15 - 14.69）是9个月时主要不良心血管事件的独立预测因素，而性别在统计学上不显著（P = 0.13）。
在冠状动脉疾病的解剖功能评估方面存在显著的性别差异，这导致了临床管理、成本和不良事件的差异。
