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Sex differences in prevalence and outcomes of the different endotypes of chronic coronary syndrome in symptomatic patients undergoing invasive coronary angiography: Insights from the global ILIAS invasive coronary physiology registry

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posted on 2024-01-08, 11:55 authored by Caitlin EM Vink, Janneke Woudstra, Joo Myung Lee, Coen KM Boerhout, Christopher M Cook, Masahiro Hoshino, Hernan Mejia-Renteria, Seung Hun Lee, Ji-Hyun Jung, Mauro Echavarria-Pinto, Martijn Meuwissen, Hitoshi Matsuo, Maribel Madera-Cambero, Ashkan Eftekhari, Mohamed A Effat, Tadashi Murai, Koen Marques, Marcel AM Beijk, Joon-Hyung Doh, Jan J Piek, Tim P van de Hoef, Evald Høj Christiansen, Rupak Banerjee, Chang-Wook Nam, Giampaolo Niccoli, Masafumi Nakayama, Nobuhiro Tanaka, Eun-Seok Shin, Niels van Royen, Steven AJ Chamuleau, Paul Knaapen, Javier Escaned, Tsunekazu Kakuta, Bon-Kwon Koo, Yolande Appelman, Guus A de Waard

Background and aims: The management of chronic coronary syndrome (CCS) is informed by studies predominantly including men. This study investigated the relationship between patients sex and different endotypes of CCS, including sex-specific clinical outcomes. Methods: In patients with CCS undergoing coronary angiography, invasive Fractional Flow Reserve (FFR) and Coronary Flow Reserve (CFR) were measured. Patients were stratified into groups: 1) obstructive coronary artery disease (oCAD) (FFR≤0.80, no revascularization), 2) undergoing revascularization, 3) non-obstructive coronary artery disease with coronary microvascular dysfunction (CMD) (FFR>0.80, CFR≤2.5), and 4) non-obstructive coronary artery disease without CMD (FFR>0.80 and CFR>2.5). Results: 1836 patients (2335 vessels) were included, comprising 1359 (74.0%) men and 477 (26.0%) women. oCAD was present in 14.1% and was significantly less prevalent in women than in men (10.3% vs 15.5%, respectively p < 0.01). Revascularization was present in 30.9% and was similarly prevalent in women and men (28.2% vs. 31.9%, respectively p = 0.13). CMD was present in 24.2% and was significantly more prevalent in women than men (28.6% vs 22.6%, respectively p < 0.01). Normal invasive measurements were found in 564 patients (33.0% women vs 30.0% men, p = 0.23). Male sex was associated with an increased risk of target vessel failure compared to women (HR.1.89, 95% CI 1.12–3.18, p = 0.018), regardless of CCS-endotype. Conclusions: Sex differences exist in the prevalence and outcomes of different endotypes of CCS in symptomatic patients undergoing invasive coronary angiography. In particular, oCAD (and subsequent revascularization) were more prevalent in men. Conversely, CMD was more prevalent in women. Overall, men experienced a worse cardiovascular outcome compared to women, independent of any specific CCS endotype.  

History

Refereed

  • Yes

Volume

384

Publication title

Atherosclerosis

ISSN

0021-9150

Publisher

Elsevier BV

File version

  • Published version

Language

  • eng

Affiliated with

  • School of Medicine Outputs