Turk Kardiyol Dern Ars. 2023; 51(1): 22-31 | DOI: 10.5543/tkda.2022.75572

Gender-Dependent Comparison of Coronary Computed Tomography Angiographic Characteristics among Patients with Suspected Atherosclerosis: A Single-Center Experience

Aslan Erdoğan¹, Eyup Özkan¹, Mehmet Rasih Sonsöz¹, Ömer Genç¹, Ersin Ibişoğlu¹, Yelda Özateş¹, Duygu Inan¹, Muhammed Mert Göksu¹, Yiğit Can Kartal², Ali Fuat Tekin², Berk Erdinç¹, Gazi Çapar¹, Ahmet Güler¹, Alev Kılıçgedik¹, Ali Karagöz^3
1Clinic of Cardiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
²Clinic of Radiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
³Clinic of Cardiology,Kartal Kosuyolu Training and Research Hospital,Istanbul, Türkiye

OBJECTIVE
In this study, we aimed to examine gender-based differences in coronary artery disease (CAD) risk factors, the presence and severity of atherosclerosis, and the distribution of plaque type in patients presenting with chest pain.


METHODS
A total of 1496 patients who applied to our cardiology outpatient clinic with chest pain and underwent computed coronary tomographic angiography (CTA) between August 2020 and October 2021 were included in the study. Plaque characteristics, Agatston score, and Coronary Artery Disease-Reporting and Data System (CAD-RADS) score obtained from the patients’ CTAs were compared by gender.


RESULTS
Of the 1496 patients evaluated, 47.9% were female. Coronary atherosclerosis was detected in 35.4% of females and 52.9% of males (P <0.001). Diabetes mellitus [155 (21.8%) vs. 123 (15.7%); P <0.001] and hypertension [271 (38.1%) vs. 249 (32%); P <0.001] rates were higher in females than in males. Plaque burden and high-risk plaque rate were found to be higher in males (P <0.001). Next, the rate of moderate-to-high coronary artery stenosis (CAD-RADS ≥3) was observed at 21.6% in men and 12.2% in women (P <0.001). Agatston score was found to be higher in males than in females for all age groups (P <0.001). The severity of CAD increased sharply with age in females (P interaction = 0.003).


CONCLUSION
Although female patients demonstrated higher rates of traditional risk factors, the male gender was associated with increased coronary plaque burden, high-risk plaque, CADRADS, and Agatston scores. Therefore, patient-based approaches that consider gender-related differences could provide effective treatment and follow-up.

Keywords: Atherosclerosis, coronary artery disease severity, coronary ct angiography, coronary plaque characterization, sex-specific coronary artery disease

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