Abstract 13586: Sex-Specific Association Between Perivascular Inflammation and Plaque Vulnerability

Introduction: Females were reported to have lower levels of perivascular inflammation assessed by pericoronary adipose tissue (PCAT) attenuation than males. However, the sex-specific difference in the association between perivascular inflammation and plaque vulnerability is unknown.

Objective: The aim of this study was to investigate the sex-specific association between perivascular inflammation and plaque vulnerability.

Methods: Patients who underwent coronary computed tomography angiography (CTA) and optical coherence tomography (OCT) were enrolled. All images were analyzed at a core laboratory. The level of perivascular inflammation was assessed by PCAT attenuation on CTA and plaque vulnerability by OCT. Patients were divided into three groups according to the tertile range of PCAT attenuation (T1: ≤ -72.7 HU, T2: -72.8 - -66.9 HU, or T3: ≥ -67.0).

Results: A total of 888 lesions in 363 patients were included; 176 lesions in 77 females (2.3 plaques per patient) and 712 lesions in 286 males (2.5 plaques per patient). Females were older (median [IQR] age: 71 [66-78] vs. 64 [56-72], P <0.001) but had less severe coronary artery disease than males. Thin-cap fibroatheroma (TCFA) was more prevalent, and lipid index and macrophage grade were greater in T3 group than T1 group in females, but there was no difference among three groups in males (T3 vs. T2 vs. T1 in females: 45.5%* vs. 34.2% vs. 21.0; 1448 ± 1183* vs. 1140 ± 1000 vs. 942 ± 975; 14 ± 12* vs. 9 ± 14 vs. 7 ± 10; respectively; T3 vs. T2 vs. T1 in males: 32.0% vs. 27.1% vs. 25.0; 1273 ± 1140 vs. 1191 ± 1128 vs. 1060 ± 1138; 9 ± 12 vs. 8 ± 9 vs. 7 ± 10; respectively; * indicates P <0.05 vs. T1) (Figure).

Conclusions: A higher level of perivascular inflammation was associated with higher plaque vulnerability in females, but not in males.