Abstract 11776: Sex Differences in Coronary Artery Disease Characteristics Among Patients With Type 2 Myocardial Infarction: Results From the Prospective DEFINE-Type 2 MI Study
Claire Lin, Cian P McCarthy, Reza Mohebi, Yuxi Liu, Ron Blankstein, Campbell Rogers, Sandeep Hedgire, Sean Murphy, Hannah Miksenas, Daniel Amponsah, Paula Rambarat, Avanthi Raghavan, Allison Levin, Jason H Wasfy, Brian Ghoshhajra, James L Januzzi- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Background: Type 2 Myocardial Infarction (T2MI) is a result of coronary supply and demand imbalance and is associated with a poor prognosis. It is crucial to identify potential sex-based differences in the prevalence and nature of coronary artery disease (CAD) within this specific population. Retrospective analyses are limited by selection bias, unequal proportions of male and female subjects, and lack of angiographic definition.
Hypothesis: In patients with T2MI, women and men will have unique characteristics.
Aim: To evaluate sex-based differences in presentation, prevalence/characteristics of CAD and clinical management of T2MI.
Methods: In a single-center prospective study, patients with strictly adjudicated T2MI underwent coronary computed tomography angiography and Fractional Flow Reserve (FFR CT ) and quantitative plaque assessment was performed.
Results: Of 50 study participants enrolled, 50% were women. Women with T2MI were older than men with T2MI (72.2 ± 10.1 vs. 64 ± 11.3 years; p = 0.009) but otherwise had similar baseline characteristics. A broad and similar mix of T2MI precipitants were present among both sexes. Ischemic ST depression was more common in women (64% vs. 32%; p = 0.05) while men were more likely to have T wave inversion (68% vs. 36%; p = 0.05). Women and men had comparable CAC scores (median [Q1, Q3] 152 [45, 762] vs. 234 [56, 422]; p = 0.07). Prevalence of any CAD (100% vs. 84%; p = 0.12), obstructive CAD (28% vs. 24%; p = 1.0), and hemodynamically significant focal stenosis with FFR CT < 0.80 (64% vs. 56%; p = 0.08) were similar between men and women. While total plaque volumes were similar between men and women, women had significantly lower levels of low-attenuation plaque (median [Q1, Q3]: 3 [1,7] vs. 9 [3, 14]; p = 0.03). Men and women did not significantly differ in percentile of plaque burden. Both sexes showed comparable increases in the utilization of aspirin (OR = 0.67; p = 0.53), beta blockers (OR = 0.76; p = 0.71), and statins (OR = 0.22; p = 0.08) by discharge.
Conclusions: This prospective study of using FFRCT in T2MI identifies similarities and differences in clinical presentation and CAD characteristics of T2MI in both men and women. These findings may be helpful in improving the identification and management of T2MI.