Every drop counts: every 50mm3 plaque volume confers greater risk in women than men

Abstract Background Artificial intelligence–driven quantitative CCTA (AI-QCT) automates measurement plaque features including total plaque volume (TPV), noncalcified plaque (NCP), calcified plaque (CP) and percent atheroma volume (PAV). In the CONFIRM2 international registry of 3,551 patients (49% women), these AI-QCT plaque features, especially NCP, identified a higher risk per 50mm3 (the size of a drop of water) of major adverse cardiovascular events in women than in men (HR 1.35 vs 1.1, p < 0.01) (Figure 1) (1). The goal of our study is to evaluate site and scanner sex-specific differences in AI-QCT–derived plaque characteristics in a real-world cohort on a single energy-integrating detector-CT. Methods We retrospectively analyzed 461 patients referred for coronary CT angiography to a single scanner and narrow kVp range (120-140) under an IRB-approved protocol. Our cohort included 282 men (mean age 64.1 ± 10.9 years) and 179 women (mean age 67.1 ± 10.0 years). AI-QCT quantified TPV, NCP, CP and PAV were estimated. Continuous plaque metrics are reported as mean ± SD and median (IQR) and were compared between men and women using two-sample t-tests for normally distributed variables and Wilcoxon rank-sum tests for skewed distributions. Results Women had a significantly lower plaque burden across all three-volume metrics (Figure 2). TPV was a median of 104.1 mm³ (IQR 27–230) in women versus 349.3 mm³ (IQR 128–637) in men (p