Impact of Sex on Residual Angina After Percutaneous Coronary Interventions

Background Sex‐related differences in the clinical presentation of coronary artery disease (CAD) are well recognized. The pullback pressure gradient (PPG) characterizes pathophysiological CAD patterns as focal or diffuse. Objectives To evaluate the influence of sex on residual angina at one year after percutaneous coronary intervention (PCI), stratified by PPG. Methods We performed a sub‐analysis of PPG Global, a multicenter, prospective, single‐arm study. All patients had hemodynamically significant CAD (fractional flow reserve [FFR] ≤ 0.80) and underwent a manual FFR pullbacks to calculate PPG before PCI. Patient‐reported outcomes were collected using the 7‐item Seattle Angina Questionnaire (SAQ‐7) at baseline and 1‐year follow‐up. Results We included 814 patients (205 [25.2%] women and 609 [74.8%] men). Women were significantly older than men (70 ± 10 years vs. 67 ± 10 years p < 0.001). Baseline FFR were comparable between sexes (0.68 ± 0.13 vs. 0.66 ± 0.12, p = 0.098), but women had a more focal CAD compared to men (PPG 0.66 ± 0.15 vs. 0.63 ± 0.15, p = 0.047). Post PCI‐FFR was higher in women than men (0.88 ± 0.07 vs. 0.87 ± 0.07, p = 0.041); however, angina at 1 year was more frequent in women (SAQ angina frequency score 94 ± 12 vs. 96 ± 10, p = 0.041). Conclusion Despite having a more focal CAD pattern and achieving higher post‐PCI FFR, women report more residual angina than men at 1‐year follow‐up. Trial Registration: ClinicalTrials.gov NCT04789317.