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Impact of Sex on Residual Angina After Percutaneous Coronary Interventions

Masahiro Hada1,2, Takuya Mizukami1,3, Kazumasa Ikeda1,4

  • 1Cardiovascular Center Aalst, AZORG, Aalst, Belgium.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|December 18, 2025
PubMed

Insights

Women with coronary artery disease (CAD) experience more residual angina one year after percutaneous coronary intervention (PCI), despite having more focal disease and higher post-PCI fractional flow reserve (FFR). This highlights sex-based differences in CAD outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Outcomes Research

Background:

  • Sex-related differences in coronary artery disease (CAD) presentation are established.
  • The pullback pressure gradient (PPG) differentiates focal versus diffuse CAD pathophysiology.
  • Understanding these differences is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To investigate the influence of sex on residual angina symptoms one year post-percutaneous coronary intervention (PCI).
  • To stratify outcomes based on pullback pressure gradient (PPG) measurements.
  • To analyze patient-reported outcomes in relation to sex and CAD patterns.

Main Methods:

  • Sub-analysis of the prospective, multicenter PPG Global study.
  • Inclusion of 814 patients with hemodynamically significant CAD (FFR ≤ 0.80).
  • Measurement of PPG before PCI and collection of Seattle Angina Questionnaire (SAQ-7) data at baseline and 1-year follow-up.

Main Results:

  • Women (25.2%) were older and had more focal CAD (higher PPG) than men.
  • Despite comparable baseline FFR, women achieved higher post-PCI FFR.
  • Women reported significantly more frequent angina at 1-year follow-up compared to men.

Conclusions:

  • Women with CAD exhibit a more focal pattern and achieve better FFR post-PCI.
  • Residual angina remains more prevalent in women one year after PCI.
  • These findings underscore the need for sex-specific considerations in CAD management.
Abstract

Keywords:
coronary artery diseasepathophysiological patternpullback pressure gradientresidual anginasex difference

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