Coronary Computed Tomography Angiography Criteria in Men vs Women

Background: Atherosclerosis involves the accumulation of atheromas or fibrofatty plaques within the large-to-medium-sized arteries of the heart, potentially leading to rupture or erosion that obstructs blood flow, ultimately causing ischemic heart disease. This study aimed to assess gender-based criteria of coronary artery tree based on coronary computed tomography angiography (CCTA). Methods: This cross-section, comparative and dual center study included 1000 patients with low to intermediate risk of CAD scheduled for CCTA at the National Heart Institute and Benha University Hospital. All patients underwent ECG, Echocardiography and CCTA. Results: Prevalence of atherosclerosis in males was significantly higher than females (272 patients 51.32 % vs 185 patients 39.36 %, P=0.002). Calcium score was significantly higher in males compared to females (144.71 ± 86.82 vs 133.98 ± 81.36, P =0.045), High risk plaques (118 patients 43.21% vs 66 patients 35.74 %, P=0.016) and segment involvement score (1.43 ± 0.7 vs 1.35 ± 0.64, P =0.045) were significantly higher in males than females. The positive remodeling (372 (31.3%) vs 245 (23.2%) , P-value =0.009) , Napkin ring sign (87(7.3) vs 72(6.8), P=0.004), > 1 types of HRP (304 (25.6) vs 191(18.1,P=0.004) and stenosis severity score (2.57 ± 1.39 vs 2.37 ± 1.33 , P-value =0.025) were significantly higher in males than female. Total plaque volume was insignificantly different between both groups (P<0.001). Conclusion: Men exhibit higher coronary atherosclerosis compared to women, these disparities persist even after adjusting for socioeconomic, lifestyle, and traditional risk factors (e.g., smoking, hypertension), suggesting biological mechanisms.