Sex Differences in Atherosclerotic Coronary Artery Disease Patterns

Authors

• Kazumasa Ikeda
• Daniel Munhoz
• Sofie Brouwers
• Jeroen Sonck
• Hitoshi Matsuo
• Toshiro Shinke
• Hirohiko Ando
• Brian Ko
• Simone Biscaglia
• Fernando Rivero
• Thomas Engstrøm
• Ketina Arslani
• Antonio Maria Leone
• Domenico Galante
• Lokien X van Nunen
• William F Fearon
• Evald Høj Christiansen
• Stephane Fournier
• Liyew Desta
• Andy Yong
• Julien Adjedj
• Javier Escaned
• Masafumi Nakayama
• Ashkan Eftekhari
• Frederik M Zimmermann
• Koshiro Sakai
• Tatyana Storozhenko
• Bruno R da Costa
• Gianluca Campo
• Colin Berry
• Damien Collison
• Thomas Johnson
• Tetsuya Amano
• Divaka Perera
• Allen Jeremias
• Ziad Ali
• Bernard De Bruyne
• Frederic Bouisset
• Takashi Kubo
• Nobuhiro Tanaka
• Kazuhiro Satomi
• Nils P Johnson
• Carlos Collet
• Takuya Mizukami

Language

English

Publication Date

11-18-2025

Journal

Journal of the American Heart Association

DOI

10.1161/JAHA.124.039496

PMID

41246804

PMCID

PMC12887231

PubMedCentral® Posted Date

11-17-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Sex differences in coronary artery disease (CAD) have been increasingly recognized, as women present with distinct clinical characteristics and outcomes compared with men. This study investigated the impact of sex on pathophysiological CAD patterns (focal versus diffuse) in stable patients undergoing percutaneous coronary interventions (PCI).

Methods: We conducted a subanalysis of the PPG Global (Pullback Pressure Gradient Global Registry) study, a multicenter, prospective trial including 993 patients (236 [23.8%] women and 757 [76.2%] men) with hemodynamically significant CAD, defined as fractional flow reserve ≤0.80. The pullback pressure gradient metric categorized CAD patterns as focal or diffuse. Patient-reported outcomes were collected using the 7-item Seattle Angina Questionnaire. Optimal revascularization was defined as post-PCI fractional flow reserve ≥0.88.

Results: Women were significantly older than men, with a mean age of 69.8±10.3 years compared with 67.0±10.1 years (P< 0.001). Despite similar baseline fractional flow reserve (0.69±0.12 versus 0.67±0.11, P=0.093), women reported more severe symptoms compared with men, as reflected in the Seattle Angina Questionnaire-7 angina frequency score (mean 76.7±22.9 versus 81.5±20.3, P=0.002). Women exhibited a more focal CAD pattern (pullback pressure gradient 0.65±0.16 versus 0.61±0.16, P=0.001) and achieved higher post-PCI fractional flow reserve values (0.88±0.07 versus 0.87±0.07, P=0.02). Women undergoing PCI had a higher rate of optimal revascularization (54% versus 44%, P=0.01).

Conclusions: This study reveals clinically significant differences in CAD patterns between sexes, with women demonstrating a higher burden of angina, more focal disease distribution, and better physiological results after PCI.

Keywords

Humans, Female, Male, Coronary Artery Disease, Aged, Sex Factors, Prospective Studies, Middle Aged, Percutaneous Coronary Intervention, Registries, Fractional Flow Reserve, Myocardial, Treatment Outcome, Health Status Disparities, Patient Reported Outcome Measures, coronary artery disease, fractional flow reserve, pullback pressure gradient, Seattle Angina Questionnaire, sex differences

Published Open-Access

yes

Recommended Citation

Ikeda, Kazumasa; Munhoz, Daniel; Brouwers, Sofie; et al., "Sex Differences in Atherosclerotic Coronary Artery Disease Patterns" (2025). Faculty, Staff and Student Publications. 3617.
https://digitalcommons.library.tmc.edu/uthmed_docs/3617