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Effect of Sex Difference of Coronary Microvascular Dysfunction on Long-Term Outcomes in Deferred Lesions
Ju-Hyun Chung1, Kyung Eun Lee2, Joo Myung Lee3
1Division of Cardiology, Department of Internal Medicine, Ulsan Medical Center, Ulsan Hospital, Ulsan, Republic of Korea.
Insights
Women with deferred coronary artery lesions had lower coronary flow reserve (CFR) but experienced fewer major adverse cardiovascular events (MACE) over five years compared to men, indicating better long-term outcomes despite microvascular differences.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary microvascular dysfunction is linked to adverse long-term cardiovascular outcomes.
- Coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) are key metrics for assessing microvascular function.
- Understanding sex-based differences in microvascular function and outcomes is crucial for personalized patient care.
Purpose of the Study:
- To investigate sex differences in long-term cardiovascular outcomes.
- To evaluate the relationship between coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) with outcomes in patients with deferred coronary artery lesions.
- To determine if sex influences the prognostic value of microvascular parameters.
Main Methods:
- Prospective enrollment of 434 patients (133 women, 301 men) with deferred coronary artery lesions.
- Assessment of CFR, IMR, fractional flow reserve, and quantitative coronary angiography.
- Long-term follow-up (5 years) for major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, and revascularization.
Main Results:
- Women exhibited milder epicardial disease but had lower CFR compared to men, primarily due to higher resting coronary flow.
- No significant sex difference was observed in IMR.
- Women experienced significantly lower MACE rates (1.1%) compared to men (5.5%) over 5 years.
- Sex, diabetes mellitus, and CFR were independent predictors of MACE.
- Low CFR was associated with a significantly higher risk of MACE in men, but not in women.
Conclusions:
- Despite lower CFR, women with deferred coronary artery lesions demonstrated superior long-term clinical outcomes compared to men.
- Microvascular function assessed by IMR did not differ significantly between sexes.
- CFR remains a significant predictor of MACE, with a differential prognostic impact based on sex.
Objectives:
This study investigated the sex difference of long-term cardiovascular outcomes on coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) in patients with deferred coronary artery lesions.
Background:
Coronary microvascular dysfunction is associated with poorer long-term outcomes. It can be assessed by CFR and the IMR.
Methods:
The study prospectively enrolled 434 patients (133 women and 301 men) and analyzed CFR, IMR, fractional flow reserve, and quantitative coronary angiography. Clinical outcomes were assessed by major adverse cardiovascular event(s) (MACE) of cardiac death, myocardial infarction, and revascularization during 5 years of follow-up. The study protocol was approved by the Institutional Review Board or Ethics Committee at each participating center, and all patients provided written informed consent. The study protocol was in accordance with the Declaration of Helsinki.
Results:
Women had milder epicardial disease compared with men (fractional flow reserve: 0.91 [interquartile range (IQR): 0.87 to 0.96] vs. 0.90 [IQR: 0.86 to 0.95]; p = 0.037). IMR was similar between the sexes, but CFR was lower in women (2.69 [IQR: 2.08 to 3.90] vs. 3.20 [IQR: 2.20 to 4.31]; p = 0.006) due to a shorter resting mean transit time, whereas hyperemic mean transit times were similar. At 5-year follow-up, MACE was significantly lower in women compared with men (1.1% vs. 5.5%; p = 0.017). Sex, diabetes mellitus, and CFR were independent predictors for MACE for all patients. The risk of MACE was significantly higher in men with low versus high CFR (hazard ratio: 4.58; 95% confidence interval: 1.85 to 11.30; p = 0.011) which was not seen in women.
Conclusions:
There was no sex difference in microvascular function by IMR. CFR was lower in women due to a higher resting coronary flow; however, long-term clinical outcomes in deferred lesions were better in women compared with men. (Clinical, Physiological and Prognostic Implication of Microvascular Status; NCT02186093).
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