Sex Differences in Coronary Artery Disease Characteristics Among Patients With Type 2 Myocardial Infarction.

Background: Type 2 myocardial infarction (MI) results from coronary supply and demand imbalance and has a poor prognosis. It is crucial to identify potential sex-based differences in the prevalence and nature of coronary artery disease (CAD) within this population.
Objectives: The purpose of this study was to evaluate sex-based disease differences in type 2 MI among patients evaluated with coronary computed tomography angiography and fractional flow reserve.
Methods: In a single-center, prospective study, patients with strictly adjudicated type 2 MI underwent coronary computed tomography angiography with fractional flow reserve.
Results: Among 50 study participants enrolled, 50% were women. A similar mix of MI precipitants was present in both sexes. ST-segment depression was more common in women (64% vs 32%), while men were more likely to have T wave inversion (68% vs 36%). Women and men had comparable coronary artery calcium scores (median: 152 [Q1, Q3: 45, 762] vs 234 [Q1, Q3: 56, 422]). Prevalence of any CAD (84% vs 100%), obstructive CAD (24% vs 28%), and hemodynamically significant focal stenosis (20% vs 32%) were similar between sexes. Total plaque volume was similar between sexes, but women had significantly lower levels of low-attenuation plaque (median: 3 [Q1, Q3: 1, 7] vs 9 [Q1, Q3: 3, 14]).
Conclusions: Among patients with type 2 MI, prevalence of any CAD and obstructive CAD did not differ according to sex. Total plaque volume was similar between sexes, but women had a lower volume of low-attenuation plaque (DEFINing the PrEvalence and Characteristics of Coronary Artery Disease Among Patients With TYPE 2 Myocardial Infarction Using CT-FFR [DEFINE TYPE2MI]; NCT04864119).
Competing Interests: Dr Wasfy is supported by 10.13039/100000968American Heart Association (18 CDA 34110215); is chair of the New England Comparative Effectiveness Public Affairs Council (CEPAC); has received grant support from the American Heart Association and the National Institutes of Health; and has received past consulting fees from Pfizer and Biotronik. Dr Januzzi is supported by the Hutter Family Professorship. Dr McCarthy has received consulting income from Abbott Laboratories and Roche Diagnostics. Dr Ghoshhajra is on the Executive Committee of the Society of Cardiovascular Computed Tomography (President); has received grant support from 10.13039/501100011699Siemens Healthineers and the 10.13039/100000002National Institutes of Health; and received consulting fees from Siemens Healthineers, Philips Healthcare, and 3DR Labs (all unrelated to this work). Dr Rogers is an employee and shareholder of HeartFlow, Inc. Dr Blankstein has received research support from 10.13039/100002429Amgen Inc and 10.13039/100004336Novartis Inc; and has served as a consultant/advisory board for Caristo Inc, Elucid Inc, Hearflow Inc, Beren Therapeutics, Nanox AI. Dr Januzzi is a Trustee of the American College of Cardiology; a Director at Imbria Pharmaceuticals; an Advisor at Jana Care; has received grant support from 10.13039/100001316Abbott, Applied Therapeutics, 10.13039/100020588HeartFlow Inc, Innolife, and 10.13039/100016545Roche Diagnostics; consulting income from Abbott, Janssen, Novartis, Merck, and Roche Diagnostics; and participates in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Bayer, CVRx, Intercept, Pfizer, and Takeda. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(© 2024 The Authors.)