Repository logo

Sex-Specific Computed Tomography Coronary Plaque Characterization and Risk of Myocardial Infarction.

Accepted version

No Thumbnail Available



Change log


Williams, Michelle C 
Kwiecinski, Jacek 
Doris, Mhairi 
McElhinney, Priscilla 
D'Souza, Michelle S 


OBJECTIVES: This study was designed to investigate whether coronary computed tomography angiography assessments of coronary plaque might explain differences in the prognosis of men and women presenting with chest pain. BACKGROUND: Important sex differences exist in coronary artery disease. Women presenting with chest pain have different risk factors, symptoms, prevalence of coronary artery disease and prognosis compared to men. METHODS: Within a multicenter randomized controlled trial, we explored sex differences in stenosis, adverse plaque characteristics (positive remodeling, low-attenuation plaque, spotty calcification, or napkin ring sign) and quantitative assessment of total, calcified, noncalcified and low-attenuation plaque burden. RESULTS: Of the 1,769 participants who underwent coronary computed tomography angiography, 772 (43%) were female. Women were more likely to have normal coronary arteries and less likely to have adverse plaque characteristics (p < 0.001 for all). They had lower total, calcified, noncalcified, and low-attenuation plaque burdens (p < 0.001 for all) and were less likely to have a low-attenuation plaque burden >4% (41% vs. 59%; p < 0.001). Over a median follow-up of 4.7 years, myocardial infarction (MI) occurred in 11 women (1.4%) and 30 men (3%). In those who had MI, women had similar total, noncalcified, and low-attenuation plaque burdens as men, but men had higher calcified plaque burden. Low-attenuation plaque burden predicted MI (hazard ratio: 1.60; 95% confidence interval: 1.10 to 2.34; p = 0.015), independent of calcium score, obstructive disease, cardiovascular risk score, and sex. CONCLUSIONS: Women presenting with stable chest pain have less atherosclerotic plaque of all subtypes compared to men and a lower risk of subsequent MI. However, quantitative low-attenuation plaque is as strong a predictor of subsequent MI in women as in men. (Scottish Computed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590).



computed tomography, computed tomography coronary angiography, coronary artery disease, quantitative plaque analysis, sex, Computed Tomography Angiography, Coronary Angiography, Coronary Artery Disease, Coronary Vessels, Female, Humans, Male, Myocardial Infarction, Plaque, Atherosclerotic, Predictive Value of Tests, Risk Factors

Journal Title

JACC Cardiovasc Imaging

Conference Name

Journal ISSN


Volume Title



Elsevier BV