Sex differences in machine learning computed tomography-derived fractional flow reserve

• Published in: Scientific reports Vol. 12; no. 1; p. 13861
• Main Authors: Al Rifai, Mahmoud, Ahmed, Ahmed Ibrahim, Han, Yushui, Saad, Jean Michel, Alnabelsi, Talal, Nabi, Faisal, Chang, Su Min, Cocker, Myra, Schwemmer, Chris, Ramirez-Giraldo, Juan C., Zoghbi, William A., Mahmarian, John J., Al-Mallah, Mouaz H.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 16.08.2022; Nature Publishing Group; Nature Portfolio
• Subjects: 692/4019/592/75; 692/4019/592/75/593/15/1939; Angiography; Comorbidity; Computed tomography; Coronary artery; Diabetes mellitus; Dyslipidemia; Gender differences; Humanities and Social Sciences; Hypertension; Learning algorithms; Machine learning; multidisciplinary; Myocardial infarction; Population studies; Science; Science (multidisciplinary); Sex differences; Single photon emission computed tomography; Stenosis; Tomography
• DOI: 10.1038/s41598-022-17875-9
• ISSN: 2045-2322

Coronary computed tomography angiography (CCTA) derived machine learning fractional flow reserve (ML-FFR CT ) can assess the hemodynamic significance of coronary artery stenoses. We aimed to assess sex differences in the association of ML-FFR CT and incident cardiovascular outcomes. We studied a retrospective cohort of consecutive patients who underwent clinically indicated CCTA and single photon emission computed tomography (SPECT). Obstructive stenosis was defined as ≥ 70% stenosis severity in non-left main vessels or ≥ 50% in the left main coronary. ML-FFR CT was computed using a machine learning algorithm with significant stenosis defined as ML-FFR CT  < 0.8. The primary outcome was a composite of death or non-fatal myocardial infarction (D/MI). Our study population consisted of 471 patients with mean (SD) age 65 (13) years, 53% men, and multiple comorbidities (78% hypertension, 66% diabetes, 81% dyslipidemia). Compared to men, women were less likely to have obstructive stenosis by CCTA (9% vs. 18%; p = 0.006), less multivessel CAD (4% vs. 6%; p = 0.25), lower prevalence of ML-FFR CT  < 0.8 (39% vs. 44%; p = 0.23) and higher median (IQR) ML-FFR CT (0.76 (0.53–0.86) vs. 0.71 (0.47–0.84); p = 0.047). In multivariable adjusted models, there was no significant association between ML-FFR CT  < 0.8 and D/MI [Hazard Ratio 0.82, 95% confidence interval (0.30, 2.20); p = 0.25 for interaction with sex.]. In a high-risk cohort of symptomatic patients who underwent CCTA and SPECT testing, ML-FFR CT was higher in women than men. There was no significant association between ML-FFR CT and incident mortality or MI and no evidence that the prognostic value of ML-FFR CT differs by sex.