Abstract 15599: Sex-Based Differences in Coronary Artery Morphology, Disease Distribution, and Lesion Outcomes

Abstract

Introduction: Despite the unique pathophysiology, clinical presentation, and disparities in care of women with coronary artery disease, sex-based differences in coronary morphology and their relation to disease remain poorly understood. Methods: We constructed a retrospective cohort of adult patients who underwent a coronary angiogram between 2000 and 2021 at Massachusetts General Hospital and compared dominance, branching, and coronary lesion location and severity at baseline between males and females. We mapped lesions over time and studied differences in risk of receiving a future intervention by sex of the patient and location of the lesion in the coronary tree. Results: 50,988 patients (age 65.7+12.8 years, 33.0% female) had a baseline coronary angiogram and 174,502 lesions were reported. Compared to males, females were less likely to have left or mixed dominance (15.7% vs. 17.4% p<0.001) and trifurcation of the left main (LM) (5.9% vs. 11.1%, p<0.001). Compared to males, females had more lesions reported in the left anterior descending (30.0% vs. 28.3%, p<0.001) and right coronary artery (26.5% vs. 24.4% p<0.001), and less lesions in branches - obtuse marginal, diagonal, posterior descending, and posterolateral (21.8% vs. 25.1%, p<0.001). Obstructive disease - defined as ≥50% stenosis in the LM or ≥70% stenosis in any other vessel - was less common in females (48.8% vs. 69.1% , p<0.001). 8,432 patients (age 65.8+11.0 years, 25.8% female) with 37,842 lesions were evaluated longitudinally over a median follow-up of 2.9 (IQR 0.9-6.7) years, excluding follow-up of ≤2 months. The adjusted hazard ratio for need for a future intervention was 1.16 (95% CI 1.08-1.25) in females as compared to males, but this varied significantly by location in the coronary tree and sex (Figure). Conclusions: Significant sex-based differences in coronary artery morphology, location, and disease distribution exist. Their interplay may inform future need for intervention.