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AIMS There is a lack of a reliable technique to quantify coronary artery calcification (CAC). Hence, we used optical coherence tomography (OCT) to quantitate three-dimensional CAC volume to examine its association with plaque characteristics. METHODS AND RESULTS A total of 250 patients with stable angina undergoing OCT imaging before PCI were included. CAC volume was calculated from every frame of the culprit lesion and divided into tertiles (low, intermediate and high). Quantitative calcium characteristics were assessed in 107 patients who underwent both OCT and IVUS. Increase in CAC volume was associated with reduced lipid volume index, lipid length and number of lipid plaques. Diabetes and LDL cholesterol predicted less coronary calcification whereas age and prior MI predicted increased CAC after adjusting for all clinical factors. Lipid volume index (ρ=-0.001 [-0.003 to -0.00003]; p=0.04) and mean calcium depth (ρ=-0.02 [-0.02 to -0.01]; p=0.000) were inversely related to CAC volume after adjusting for all OCT characteristics, whereas cap thickness increased with increase in CAC volume (ρ=0.01 [0.002-0.03]; p=0.02) only in unadjusted analysis. Regression analysis demonstrated a significant correlation between calcium length (ρ=0.83; p

Mortality rate differences observed between men and women presenting with acute myocardial infarction (AMI) have been the focus of clinical trials and registry analyses over the past two decades. Despite advances in cardiovascular therapies over this time, studies have shown that women presenting with AMI have increased early mortality compared to their male counterparts. The cause of mortality discrepancy after AMI in women has been the subject of much debate and has become one of many areas of interest regarding sex-specific outcomes in cardiovascular disease (CVD). Research suggests potential baseline risk profile differences and treatment biases among women compared to men as a reason for the AMI mortality gap. While the exploration of gender differences in coronary artery disease (CAD) has increased, the low proportion of female patients included in CVD trials as well as the lack of published studies results sorted by sex, leaves this an area in need of further study. The current issue of EuroIntervention includes two papers addressing this topic. Both studies assessed different European populations for gender-related differences in mortality after STsegment elevation myocardial infarction (STEMI) and come to the conclusions that female gender is an independent predictor of inhospital mortality following AMI. Benamer et al analysed 16,760 patients (3,664 women) treated by PCI for STEMI from 2003 to 2007 in the CARDIO-ARHIF registry and determined that women tended to be older, had more diabetes, were more likely to present in cardiogenic shock and had a lower success rate of PCI when compared to men. After multivariate logistic regression adjusted for these risks, the authors concluded female gender was associated with higher in-hospital mortality (OR 1.38 [1.16-1.63], p=0.0002) but only after age of 75. Sadowski and colleagues analysed 26,035 consecutive patients (8,989 women) with STEMI enrolled in the Polish Registry of Acute Coronary Syndromes (PL-ACS). Like Benamer’s study, Sadowski et al determined these women were older with higher incidences of comorbidities such as hypertension, diabetes, obesity (BMI>30kg/m) and cardiogenic shock at presentation compared to males, and found a higher in-hospital mortality (1.13 [1.01-1.26], p