Relation of gender to atherosclerotic plaque characteristics by differing angiographic stenosis severity

Rebecca Jonas*, Toral Patel, Tami R. Crabtree, Robert S. Jennings, Ran Heo, Hyung Bok Park, Hugo Marques, Hyuk Jae Chang, Wijnand J. Stuijfzand, Alexander R. van Rosendael, Jung Hyun Choi, Joon Hyung Doh, Ae Young Her, Bon Kwon Koo, Chang Wook Nam, Sang Hoon Shin, Jason Cole, Alessia Gimelli, Muhammad Akram Khan, Bin LuYang Gao, Faisal Nabi, Mouaz H. Al-Mallah, Ryo Nakazato, U. Joseph Schoepf, Roel S. Driessen, Michiel J. Bom, Randall C. Thompson, James J. Jang, Michael Ridner, Chris Rowan, Erick Avelar, Philippe Généreux, Paul Knaapen, Guus A. de Waard, Gianluca Pontone, Daniele Andreini, Jeroen J. Bax, Andrew D. Choi, James P. Earls, Udo Hoffmann, James K. Min, Todd C. Villines

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review



It is unknown whether gender influences the atherosclerotic plaque characteristics (APCs) of lesions of varying angiographic stenosis severity. This study evaluated the imaging data of 303 symptomatic patients from the derivation arm of the CREDENCE (Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia) trial, all of whom underwent coronary computed tomographic angiography and clinically indicated nonemergent invasive coronary angiography upon study enrollment. Index tests were interpreted by 2 blinded core laboratories, one of which performed quantitative coronary computed tomographic angiography using an artificial intelligence application to characterize and quantify APCs, including percent atheroma volume (PAV), low-density noncalcified plaque (LD-NCP), noncalcified plaque (NCP), calcified plaque (CP), lesion length, positive arterial remodeling, and high-risk plaque (a combination of LD-NCP and positive remodeling ≥1.10); the other classified lesions as obstructive (≥50% diameter stenosis) or nonobstructive (<50% diameter stenosis) based on quantitative invasive coronary angiography. The relation between APCs and angiographic stenosis was further examined by gender. The mean age of the study cohort was 64.4 ± 10.2 years (29.0% female). In patients with obstructive disease, men had more LD-NCP PAV (0.5 ± 0.4 vs 0.3 ± 0.8, p = 0.03) and women had more CP PAV (11.7 ± 1.6 vs 8.0 ± 0.8, p = 0.04). Obstructive lesions had more NCP PAV compared with their nonobstructive lesions in both genders, however, obstructive lesions in women also demonstrated greater LD-NCP PAV (0.4 ± 0.5 vs 1.0 ± 1.8, p = 0.03), and CP PAV (17.4 ± 16.5 vs 25.9 ± 18.7, p = 0.03) than nonobstructive lesions. Comparing the composition of obstructive lesions by gender, women had more CP PAV (26.3 ± 3.4 vs 15.8 ± 1.5, p = 0.005) whereas men had more NCP PAV (33.0 ± 1.6 vs 26.7 ± 2.5, p = 0.04). Men had more LD-NCP PAV in nonobstructive lesions compared with women (1.2 ± 0.2 vs 0.6 ± 0.2, p = 0.02). In conclusion, there are gender-specific differences in plaque composition based on stenosis severity.

Original languageEnglish
Pages (from-to)276-283
Number of pages8
JournalThe American journal of cardiology
Publication statusPublished - 1 Oct 2023


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