Gabara, Lavinia, Hinton, Jonathon, Kira, Mohamed, Shambrook, James, Abbas, Ausami, Wilding, Sam, Leipsic, Jonathon, Douglas, Pamela S. and Curzen, Nick (2024) Sex differences in computed tomography coronary stenosis severity versus flow impairment and impact on revascularization, clinical events and healthcare costs: a FORECAST substudy: sex differences in coronary artery disease assessment and outcomes: FORECAST substudy. Journal of the American Heart Association. (doi:10.1161/JAHA.123.029950). (In Press)
Abstract
Background: the impact of sex related differences in coronary atheroma and flow impairment severity on clinical events and costs remains unclear.
Methods and Results: this is a secondary analysis of patients with stable coronary artery disease (CAD) who underwent both coronary computed tomography angiography (CCTA) and fractional flow reserve derived from computed tomography (FFRCT) as part of the FORECAST trial, investigating: (a) the relationship between coronary stenosis severity on CCTA and FFRCT by sex and (b) the association with revascularization, resource utilization and adverse clinical events. 212 patients (64 female participants, 32.1%) and 1245 vessels were included. There was no significant sex difference in the frequencies of significant (38.2% of females vs 51.3% of males, p=0.073) but female participants had significantly less coronary flow impairment, according to the presence of at least one FFRCT≤0.8 (47.0% vs 71.5%, p=0.008). Female subjects underwent fewer revascularization procedures (23.5% vs 42.3%, p=0.014), less CABG (2.9% vs 13.1%, p=0.025) and were less likely to be on statin treatment (72.0% vs 84.7%, p=0.022) by 9-month follow-up. This resulted in lower overall healthcare costs for female participants compared with male counterparts (median total cost £1276 vs £2051, p=0.014). In multivariable Cox analysis the presence of significant CAD (HR 2.91; 95% confidence interval [CI] 1.30-6.51) and having a positive FFRCT (HR 4.11; 95% CI 1.15-14.69) were independent predictors of MACE at 9-months, whereas sex was not statistically significant (p=0.13).
Conclusions: there are significant sex differences in the anatomico-functional assessment of coronary artery disease leading to differences in clinical management, costs and adverse events.
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