Artificial intelligence-enabled plaque characterization from coronary computed tomography establishes basis of angina in women with nonobstructive atherosclerosis

BACKGROUND: Half of women with ischemic symptoms have non-obstructive coronary artery disease (CAD), while the pathophysiology of their condition has not been characterized. Noncalcified (NCP) and low-attenuation plaque (CT density 60. Patients with SAQ ≤ 60 have higher total plaque (33.3 vs 24.3%, p = 0.001), and NCP burden (33.3 vs. 23.2%, p = 0.00065), and lower CP burden (0.0 vs. 0.3%, p = 0.005) compared with patients with SAQ > 60. On multivariable linear regression adjusted for risk factors, higher NCP burden (β = -0.50, p = 0.001), LAP burden (β = -4.50, p = 0.008) and ML-IRS (β = -3.09, p = 0.04) are associated with lower SAQ score, i.e. more severe angina. CONCLUSIONS: In women with INOCA, high-risk atherosclerotic plaque phenotypes are related to more severe angina.