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.