Sex differences in coronary atherosclerotic plaque activity using 18F-sodium fluoride positron emission tomography

• Published in: European journal of nuclear medicine and molecular imaging 2024-11, Vol.51 (13), p.3934-3943
• Main Authors: Kwiecinski, Jacek, Wang, Kang-Ling, Tzolos, Evangelos, Moss, Alastair, Daghem, Marwa, Adamson, Philip D., Dey, Damini, Molek-Dziadosz, Patrycja, Dawson, Dana, Arumugam, Parthiban, Sabharwal, Nikant, Greenwood, John P., Townend, John N., Calvert, Patrick A., Rudd, James HF, Berman, Daniel, Verjans, Johan W., Williams, Michelle C., Slomka, Piotr, Dweck, Marc R., Newby, David E.
• Format: Article
• Language: English
• Subjects: Angiography; Arteriosclerosis; Atherosclerosis; Calcium; Cardiology; Cardiovascular disease; Comorbidity; Computed tomography; Coronary artery disease; Fluorides; Fluorine isotopes; Gender differences; Heart attacks; Heart diseases; Imaging; Medical imaging; Medicine; Medicine & Public Health; Men; Myocardial infarction; Nuclear Medicine; Oncology; Original Article; Orthopedics; Positron emission; Positron emission tomography; Radiology; Sex differences; Sodium fluoride; Tomography; Women
• ISSN: 1619-7070; 1619-7089; 1619-7089
• DOI: 10.1007/s00259-024-06810-x

Introduction There are sex differences in the extent, severity, and outcomes of coronary artery disease. We aimed to assess the influence of sex on coronary atherosclerotic plaque activity measured using coronary 18 F-sodium fluoride ( 18 F-NaF) positron emission tomography (PET), and to determine whether 18 F-NaF PET has prognostic value in both women and men. Methods In a post-hoc analysis of observational cohort studies of patients with coronary atherosclerosis who had undergone 18 F-NaF PET CT angiography, we compared the coronary microcalcification activity (CMA) in women and men. Results Baseline 18 F-NaF PET CT angiography was available in 999 participants (151 (15%) women) with 4282 patient-years of follow-up. Compared to men, women had lower coronary calcium scores (116 [interquartile range, 27–434] versus 205 [51–571] Agatston units; p  = 0.002) and CMA values (0.0 [0.0-1.12] versus 0.53 [0.0-2.54], p  = 0.01). Following matching for plaque burden by coronary calcium scores and clinical comorbidities, there was no sex-related difference in CMA values (0.0 [0.0-1.12] versus 0.0 [0.0-1.23], p  = 0.21) and similar proportions of women and men had no 18 F-NaF uptake (53.0% ( n  = 80) and 48.3% ( n  = 73); p  = 0.42), or CMA values > 1.56 (21.8% ( n  = 33) and 21.8% ( n  = 33); p  = 1.00). Over a median follow-up of 4.5 [4.0–6.0] years, myocardial infarction occurred in 6.6% of women ( n  = 10) and 7.8% of men ( n  = 66). Coronary microcalcification activity greater than 0 was associated with a similarly increased risk of myocardial infarction in both women (HR: 3.83; 95% CI:1.10-18.49; p  = 0.04) and men (HR: 5.29; 95% CI:2.28–12.28; p