Sex Differences in Atherosclerotic Coronary Artery Disease Patterns

作者：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, Stéphane Fournier, Liyew Desta, A. 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 G. Johnson, Tetsuya Amano, Divaka Perera, Allen Jeremias, Ziad A. Ali, Bernard De Bruyne, Frédéric Bouisset, Takashi Kubo, Nobuhiro Tanaka, Kazuhiro Satomi, Nils P. Johnson, Carlos Collet, Takuya Mizukami · 发表于：Journal of the American Heart Association · 年份：2025 · DOI：10.1161/jaha.124.039496 · 被引用次数：1 · 研究领域：Acute Myocardial Infarction Research、Sex and Gender in Healthcare、Cardiac Imaging and Diagnostics

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 under...