Coronary computed tomography angiography-derived fractional flow reserve (FFRCT) differs between sexes, as women have a higher FFRCT for the same degree of stenosis, according to a study published Dec. 7 in JACC: Cardiovascular Imaging.

Timothy A. Fairbairn, MBChB, PhD, et al., analyzed patients with symptoms suggestive of coronary artery disease (CAD) on coronary computed tomography angiography (CCTA) as part of the ADVANCE registry study. A total of 4,737 patients underwent CCTA and FFRCT, and the researchers captured demographics, symptom status, CCTA anatomy, coronary volume to myocardial mass ratio (V/M), lowest FFRCT values and management plans.

Results showed that women were older compared to men, (age 68 ± 10 years vs. 65 ± 10 years) with more atypical symptoms (41.5% vs. 33.9%). Women also had less obstructive CAD at CCTA, higher FFRCT and lower likelihood of positive FFRCT ≤ 0.80 for the same degree stenosis.

Furthermore, positive FFRCT ≤ 0.80 resulted in equal referral to invasive coronary angiography, but more nonobstructive CAD and less revascularization in women, unless the FFRCT was ≤ 0.75 where revascularization rates were similar.

The researchers also discovered that women had a higher V/M ratio that is associated with higher FFRCT independent of degree stenosis.

"The findings suggest that CAD and FFRCT variations by sex need specific interpretation as these differences may affect therapeutic decision-making and clinical outcomes," the researchers conclude.

In a related editorial comment, Edward D. Nicol, MD, FACC, and Jonathan R. Weir-McCall, MBChB, PhD, note that "despite uncertainty and ambiguity around the V/M results, what this study makes clear is that when there is severe flow limitation across a stenosis, CCTA combined with FFRCT allows a more informed decision of whom to refer for invasive coronary angiography, irrespective of the sex of the patient." They add, "This is an important step forward, given the continued low rates of revascularization in women using CCTA alone."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging

Keywords: Coronary Angiography, Coronary Artery Disease, Fractional Flow Reserve, Myocardial, Constriction, Pathologic, Registries, Tomography, X-Ray Computed

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