Sex Differences in Coronary Artery Anatomy in Chest Pain Patients Investigated With Coronary Angiography

Background: Acute coronary syndrome (ACS) can present differently in men and women. This study aimed to assess sex differences in coronary artery anatomy in a cohort of patients presenting to the emergency department (ED) with undifferentiated chest pain and who underwent investigation with coronary angiography.Methods: Data were analysed from two prospective studies conducted at an Australian tertiary hospital between 2007 and 2014. Patients eligible for inclusion were those at least 18 years of age and presenting to the ED with > 5 minutes of chest pain. Outcomes measured included 30-day ACS, and rates of coronary angiography. Of those patients investigated with angiography, coronary anatomy findings were compared, including rates of normal arteries, disease severity, and single vs multivessel significant disease. Results: A total of 2,349 (60% men) patients were included in the analysis, with 153 men and 41 women diagnosed with ACS. A total of 255 (18%) men and 106 (11.4%) women were investigated with coronary angiography, yet 45.8% of these women had normal coronary arteries compared to 18.8% of the men (a difference of 27%, 95% CI 15.9–38.2). Of those with coronary artery disease present, 55.6% of men had severe disease compared to 32.3% of women (a difference of 23.3%, 95% CI 11.9–34.6). Rates of single and multivessel disease were similar. Conclusion: These findings confirm that sex differences in the manifestations of ACS exist and that not all women may benefit from invasive coronary angiography. Different strategies for investigation of possible cardiac chest pain in men and women may be indicated