Sex differences in coronary inflammation and clinical outcomes among patients with plaque-positive, nonobstructive coronary artery disease: a long-term dual-centre follow-up study
Authors' conclusion
Among patients with plaque-positive nonobstructive CAD, males exhibited worse long-term outcomes than females and showed a stronger association with coronary inflammation. pFAI is independently associated with long-term prognosis and may enhance risk stratification in these patients.
Study context
- Population
- Patients with plaque-positive nonobstructive coronary artery disease (CAD) who underwent coronary computed tomography angiography (CCTA)61 ± 10 years, 55.2% males
- Participants
- 1,395 patients
- Exposure
- Sex differences in coronary inflammation (pericoronary fat attenuation index (pFAI)) and their impact on clinical outcomes
- Outcome
- MACEs
- Follow-up
- Median 85 months (interquartile range: 72-99)
Methodological detailsretrospective
- Retrospective
Main finding
As reported in the abstract
Patients experienced major adverse cardiovascular events (MACEs)
177
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | P value |
|---|---|---|
| Elevated coronary inflammation (pFAI > −70.1 HU)Independently associated | odds ratio 1.36 | P = 0.047 |
| Cumulative rate of MACEMale vs Female · significantly higher in male patients | P < 0.001 | |
| Long-term outcomes by coronary inflammationCoronary inflammation vs No coronary inflammation | all P < 0.001 | |
| MACEs, multivariable Cox regressionIndependently associated | hazard ratio 2.33 | P < 0.001 |
- Long-term outcomes by coronary inflammation: significantly worse with coronary inflammation; consistent in male and female subgroups
Incremental prognostic value of pFAI beyond clinical variables and traditional CCTA metrics
- Area under the receiver operating characteristic curve
- 0.683-0.781
- P
- P < 0.001
Original publication
Sex differences in coronary inflammation and clinical outcomes among patients with plaque-positive, nonobstructive coronary artery disease: a long-term dual-centre follow-up study. Eur Heart J Qual Care Clin Outcomes. Published 22 August 2026. doi:10.
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