Contemporary Data on Sex Differences in Coronary Angiography Findings: A Dual-Nation Study

Area of Science:

• Cardiology
• Vascular Medicine
• Diagnostic Imaging

Background:

• Sex differences in diagnostic yield of invasive coronary angiography (ICA) for non-ST-elevation acute coronary syndrome (NSTE-ACS) are known.
• Contemporary data incorporating high-sensitivity troponin era and cross-national validation are limited.

Purpose of the Study:

• Assess sex differences in diagnostic yield, revascularization rates, and 1-year outcomes.
• Evaluate patients undergoing first-time ICA for suspected NSTE-ACS.

Main Methods:

• Utilized data from Swedish and Danish registries (totaling 92,746 patients).
• Included adults without prior coronary artery disease (CAD) undergoing first-time ICA.
• Primary outcome: absence of significant CAD (<50% stenosis). Analyzed using multivariable Poisson regression.

Main Results:

• Women had approximately double the proportion without significant CAD compared to men (40.9% vs 17.2% in Sweden; 50.1% vs 25.2% in Denmark).
• In women <50 years old with no traditional risk factors, 74.8% had no significant CAD.
• Adjusted risk ratios (aRRs) confirmed higher likelihood of no significant CAD in women.

Conclusions:

• 40-50% of women undergoing first-time ICA for NSTE-ACS had no significant CAD, twice the proportion in men.
• Highlights ongoing challenges in risk stratification for NSTE-ACS patients referred for ICA.
• Sex disparities in diagnostic yield persist in the high-sensitivity troponin era.