Female predominant coronary tortuosity is related to significant coronary artery disease. A prospective observational study

Background: Coronary tortuosity (CT), quantified by our new tortuosity severity index (TSI), strongly predicts anginal pain in patients with normal coronary angiography (CA). The connection between CT and coronary arteriosclerosis is still imprecise. Objectives: The objective was to study CT in patients with coronary artery disease (CAD). Patients and Methods: This is a prospective study at university hospitals between May 2016 and January 2017. We included 331 consecutive patients who underwent CA due to typical chest pain and showed CAD with a lesion >30%. Patients were prospectively divided into two groups based on the presence (n = 186) or absence (n = 145) of significant CAD (≥70%) and compared for clinical, echocardiographic, and CA characteristics. The TSI was either significant (mild/moderate CT with >4 curvatures in total or severe/extreme CT with any number of curvatures) or not significant TSI (mild/moderate CT with curvatures ≤4 curvatures in total). Results: Patients with significant CAD had the highest rate of CT (66% vs. 17%, P ≤ 0.001) and significant TSI (69% vs. 20%, P < 0.001) compared to those without. CT affects the left anterior descending coronary artery in middle and distal segments as a single vessel in 80% of patients. Patients with CT were more commonly females and hypertensives with small body surface area. Multivariate logistic regression analysis identified female gender (odds ratio [OR] = 4.7, confidence interval [CI] = 2.4–8.9) and CT as the main predictors of significant CAD (OR = 6.7, CI = 3.2–14.2). Conclusions: CT with significant TSI is positively related with significant CAD. This finding is more pronounced among hypertensive females with small body surface area.