What question did this study set out to answer?

To examine differences in prognostic significance of coronary CT angiography measures of plaque burden between younger men and women under 60.

April 4, 2026Open Access

Differences of plaque burden measures on CCTA in younger men and women

Puntos clave

To examine differences in prognostic significance of coronary CT angiography measures of plaque burden between younger men and women under 60.
Analyzed data from 3813 patients without CAD history who underwent CCTA from 2007-2019.
Assessed plaque burden using stenosis severity, segment involvement score (SIS), segment stenosis score (SSS), and coronary artery calcium (CAC) scores.
Conducted follow-up to determine outcomes of all-cause mortality (ACM) and non-fatal myocardial infarction (NFMI).
Observed 180 cases of ACM over an average follow-up of 7.4 years.
Men had higher severity of stenosis and plaque measures compared to women (all p<0.001).
Younger women had a significantly higher risk of ACM with increased plaque burden measures compared to men, with hazard ratios ranging from 6.52 to 9.62.

Resumen

• Semi-quantified measures of plaque burden by coronary CT angiography (CCTA) are associated with a higher risk of all-cause mortality; and all-cause mortality and nonfatal MI in younger women compared to men. • Greater risk stratification was observed in young women in all measured CCTA variables including the severity of coronary stenosis, measurements of plaque extent, extent and severity and CAC in comparison to men. • Whether these differences reflect biological factors or treatment differences remains to be determined. The extent and severity of coronary artery disease (CAD) on coronary CT angiography (CCTA) is predictive of mortality, cardiovascular death, and non-fatal myocardial infarction in both men and women; however, associations of various measures of coronary plaque burden with prognosis in younger women and men has had little study. To compare prognostic significance of CAD plaque burden and distribution on CCTA in women and men 4 HR 6.94 vs 1.68, interaction p=0.006), SSS (SSS>6 HR 7.91 vs 1.79, interaction p=0.006) and CAC (CAC>300 HR 9.62 vs 1.82, interaction p=0.004). All plaque burden measures discriminated events in women better than men, with C-statistics for multivariable models ranging from 0.729-0.760 in women, compared to 0.674-0.690 in men. Findings were similar for ACM/NFMI. Prognostic significance of multiple measures of plaque burden identified by CCTA had greater prognostic impact in younger women, compared with younger men. NA

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