Background: Sex variations in coronary artery disease (CAD) are well documented. However, sex differences in coronary artery calcium (CAC) and its role in the detection of coronary artery stenosis remain controversial. Objective: To assess the impact of sex variation on coronary artery calcification and its efficacy in predicting coronary artery stenosis. Methods: This is a cross-sectional observational study including 230 consecutive patients with suspected CAD (120 men and 110 women) referred for coronary computed tomography angiography (CCTA). The study analyzed sex-based differences in the sensitivity and specificity of coronary artery calcification (CAC) for detecting moderate to severe stenosis across various coronary arteries. Results: The calcification scores 1-100 and 101-<400 were slightly more frequent in men (25% and 10%, respectively) than women (20.91% and 7.27%, respectively); however, the differences were not significant. For the left anterior descending artery (LAD), men showed slightly higher sensitivity and specificity (69.23% and 81.48%, respectively) than women (61.9% and 79.78%, respectively). For the left circumflex artery (LCX), men showed relatively higher sensitivity (68.75%) and lower specificity (89.42%) than women (50% and 98.81%, respectively). For the right coronary artery (RCA), women showed relatively higher sensitivity and specificity (75% and 93.4%, respectively) than men (50% and 91.82%, respectively). Conclusions: While the CAC has a relatively high specificity and low sensitivity in the detection of coronary artery disease, there is no difference in the score between men and women. When comparing vessels, women exhibit greater RCA calcification sensitivity and specificity than men, whereas for LAD, the opposite is true.
