Impact of sex on residual angina stratified by pathophysiological disease pattern

Background Significant differences in the presentation of coronary artery disease (CAD) have been observed between men and women. PPG characterizes pathophysiological pressure loss patterns as focal or diffuse. This study aimed to investigate the influence of sex on residual angina stratified by PPG. Methods We performed a sub-analysis of the PPG Global study, a multicenter, prospective, single-arm study trial. All patients had hemodynamically significant CAD (FFR ≤ 0.80) and underwent a manual FFR pullback to calculate the pullback pressure gradient (PPG) before percutaneous coronary intervention. Patients reported outcomes were collected using the 7-item Seattle Angina Questionnaire (SAQ-7) at baseline and one-year follow-up. Freedom from angina was defined as SAQ angina frequency equal to 100. This analysis included 814 patients (205 [25.2%] women and 609 [74.8%] men) with complete SAQ data at one year. We investigated the contributing factors associated with residual angina according to sex and PPG. Results Women were significantly older than men (70.2 ± 10.2 years vs 67.2 ± 10.0 years p-value < 0.001). Baseline FFR were comparable between sexes (0.68 ± 0.13 vs. 0.66 ± 0.12, p-value = 0.098); women had a more focal CAD compared to men (PPG 0.66 ± 0.15 vs. 0.63 ± 0.15, p-value = 0.047). Post PCI-FFR was higher in women compared to men (0.88 ± 0.07 vs. 0.87 ± 0.07, p-value = 0.041). Residual angina was greater in women than men (SAQ angina frequency 94.4 ± 12.4 vs 96.1 ± 9.6, p-value =0.041). At one year, freedom from angina was lower in women compared to men (74.6% vs 80.5%, p-value = 0.095). PPG was an independent predictor for angina improvement (p = 0.022). Conclusion Despite having a more focal CAD pattern, women have more residual angina than men at one-year follow-up.