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Xie, Joe X.; Eshtehardi, Parham; Varghese, Tina; Goyal, Abhinav; Mehta, Puja K.; Kang, William; Leipsic, Jonathon; Hartaigh, Briain O.; Merz, C. Noel Bairey; Berman, Daniel S.; Gransar, Heidi; Budoff, Matthew J.; Achenbach, Stephan; Callister, Tracy Q.; Marques, Hugo; Rubinshtein, Ronen; Al-Mallah, Mouaz H.; Andreini, Daniele; Pontone, Gianluca; Cademartiri, Filippo; Maffei, Erica; Chinnaiyan, Kavitha; Raff, Gilbert; Hadamitzky, Martin; Hausleiter, Jörg; Feuchtner, Gudrun; Kaufmann, Philipp A.; Villines, Todd C.; Chow, Benjamin J. W.; Min, James K. and Shaw, Leslee J. (2017): Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Women Versus Men Long-Term Outcomes From the CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter) Registry. In: Circulation-Cardiovascular Imaging, Vol. 10, No. 8, e006246

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Background-Patients with obstructive (<= 50% stenosis) left main (LM) coronary artery disease (CAD) are at high risk for adverse events;prior studies have also documented worse outcomes among women than men with severe multivessel/LM CAD. However, the prognostic significance of nonobstructive (1%-49% stenosis) LM CAD, including sex-specific differences, has not been previously examined. Methods and Results-In the long-term CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter) registry, patients underwent elective coronary computed tomographic angiography for suspected CAD and were followed for 5 years. After excluding those with obstructive LM CAD, 5166 patients were categorized as having normal LM or nonobstructive LM (18% of cohort). Cumulative 5-year incidence of death, myocardial infarction, or revascularization was higher among patients with nonobstructive LM than normal LM in both women and men: women (34.3% versus 15.4%;P<0.0001);men (24.6% versus 18.2%;P<0.0001). A significant interaction existed between sex and LM status for the composite outcome (P=0.001). In multivariable Cox regression, the presence of nonobstructive LM plaque increased the risk for the composite outcome in women (adjusted hazard ratio, 1.48;P=0.005) but not in men (adjusted hazard ratio, 0.98, P=0.806). In subgroup analysis, women with nonobstructive LM CAD had a nearly 80% higher risk for events than men with nonobstructive LM CAD (adjusted hazard ratio, 1.78;P=0.017);sex-specific interactions were not observed across other patterns (eg, location or extent) of nonobstructive plaque. Conclusion-Nonobstructive LM CAD was frequently detected on coronary computed tomographic angiography and strongly associated with adverse events among women. Recognizing the sex-specific prognostic significance of nonobstructive LM plaque may augment risk stratification efforts.

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