TCT-776 Sex differences in coronary artery disease patterns.

Abstract

Background: Significant variations in clinical presentation, natural history, and prognosis between sexes have been reported in individuals with coronary artery disease (CAD). Fractional flow reserve (FFR) has been shown to yield higher values in women than men. However, the sex differences in CAD patterns (focal vs diffuse) defined by coronary physiology remain to be studied. Method(s): This prospective study was performed at 25 sites and enrolled patients with at least 1 epicardial lesion with an FFR <=0.80 intended to be treated by PCI. All patients underwent a standardized physiologic protocol that mandated FFR pullbacks with pullback pressure gradient (PPG) calculation. The aim was to compare CAD patterns, defined by PPG, between sexes. Result(s): Overall, 1,004 patients were included in the analysis, 236 women (250 vessels) and 768 men (794 vessels). Women were older (69.8 +/- 10.3 vs 67.0 +/- 10.1; P < 0.001), less frequently smokers (9.7% vs 18.6%; P = 0.002), had less previous PCI in a nontarget vessel (19.1% vs 30.6%; P = 0.001), and had less previous MI (14.4% vs 21.5%; P = 0.021). On the baseline 7-item Seattle Angina Questionnaire (SAQ-7), females reported more physical limitation (70.9 +/- 29.5 vs 80.9 +/- 25.1; P < 0.001), more frequent angina (76.7 +/- 22.9 vs 81.5 +/- 20.3; P = 0.002), and a lower quality of life (51.8 +/- 29.4 vs 57.8 +/- 29.1; P = 0.006) than men for the same degree of flow reduction (FFR 0.69 +/- 0.12 vs 0.67 +/- 0.11; P = 0.098). In women, the pattern of CAD demonstrated a more focal nature compared with men (PPG: 0.65 +/- 0.16 vs 0.61 +/- 0.16; P = 0.001). Also, women achieved higher post-PCI FFR (0.88 +/- 0.07 vs 0.87 +/- 0.07; P = 0.02). The rates of periprocedural injury or MI were not statistically different between sexes (41.3% vs 44.2% [P = 0.794] and 6.2% vs 8.2% [P = 0.407]). Conclusion(s): Among patients with hemodynamically significant CAD, women report more symptoms and lower quality of life. Despite sharing a similar degree of flow impairment, women exhibited a more focal CAD phenotype than men, leading to superior physiologic outcomes after PCI. Categories: IMAGING AND PHYSIOLOGY: Physiologic Lesion Assessment.Copyright © 2024