Sex Differences in Atherosclerotic Coronary Artery Disease Patterns

Area of Science:

• Cardiology
• Interventional Cardiology
• Sex Differences in Medicine

Background:

• Increasing recognition of sex differences in coronary artery disease (CAD) presentation and outcomes.
• Women often exhibit distinct clinical characteristics compared to men with CAD.
• This study focuses on sex-based disparities in CAD pathophysiology and percutaneous coronary intervention (PCI) outcomes.

Purpose of the Study:

• To investigate the impact of sex on coronary artery disease (CAD) pathophysiological patterns.
• To compare focal versus diffuse CAD patterns in stable patients undergoing percutaneous coronary interventions (PCI).
• To analyze sex-specific differences in patient-reported outcomes and revascularization success post-PCI.

Main Methods:

• Subanalysis of the PPG Global Registry (Pullback Pressure Gradient Global Registry) study.
• Inclusion of 993 patients (23.8% women) with hemodynamically significant CAD (fractional flow reserve ≤0.80).
• Categorization of CAD patterns (focal vs. diffuse) using pullback pressure gradient; assessment of patient-reported outcomes via Seattle Angina Questionnaire; definition of optimal revascularization (post-PCI fractional flow reserve ≥0.88).

Main Results:

• Women were older (mean 69.8 years vs. 67.0 years) and reported more severe angina frequency.
• Women showed a more focal CAD pattern (pullback pressure gradient 0.65 vs. 0.61) and achieved higher post-PCI fractional flow reserve (0.88 vs. 0.87).
• Women undergoing PCI had a significantly higher rate of optimal revascularization (54% vs. 44%).

Conclusions:

• Clinically significant sex differences exist in coronary artery disease (CAD) patterns.
• Women exhibit a higher burden of angina and a more focal disease distribution.
• Percutaneous coronary intervention (PCI) in women results in better physiological outcomes and higher rates of optimal revascularization.