Key result
Female sex is linked to more focal CAD with higher pullback pressure gradient vs. men.
Why the study?
Sex differences in coronary artery disease have been increasingly recognized, but the impact of sex on pathophysiological focal versus diffuse disease patterns in stable patients undergoing PCI was unclear.
Does sex impact pathophysiological CAD patterns (focal versus diffuse) and physiological outcomes in stable patients undergoing PCI?
Observational (n=993)
Yes
Does sex impact pathophysiological CAD patterns (focal versus diffuse) and physiological outcomes in stable patients undergoing PCI?
Women with stable CAD undergoing PCI exhibit more focal disease distribution, higher angina burden, and better post-PCI physiological results compared to men.
May inform sex-specific angina assessment pre-PCI; hypothesis-generating and requires prospective validation before practice change.
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. 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.
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Ikeda et al. (2025) conducted an observational in Coronary artery disease (n=993). Female sex vs. Male sex was evaluated on Pullback pressure gradient (PPG) (p=0.001). Women with hemodynamically significant coronary artery disease exhibited a more focal disease pattern with a higher pullback pressure gradient (0.65 vs 0.61, P=0.001) compared to men.
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