Sex Differences in Outcomes in Patients With Stable Angina
Sex Differences in Outcomes in Patients With Stable Angina
Coronary artery disease status by sex is presented in Table I. Of the 13,695 patients, most had obstructive CAD, a minority had non-obstructive CAD, and >15% had no CAD. More than one-third of women had no CAD compared with <10% of men. Women also had a significantly higher proportion of nonobstructive CAD compared with men. Table II summarizes the extent of single, double, and triple vessel CAD in the obstructive group by modified Duke criteria according to sex.
Baseline demographic and clinical characteristics for women and men by CAD status are presented in Table III. In the nonobstructive CAD category, women were older, had more hypertension, and more cancer but smoked less (all P < .001).
The Kaplan-Meier curves for freedom from MACE grouped by sex and CAD status are shown in Figure 2. In the first year after coronary angiography, women with nonobstructive CAD had a significantly worse prognosis compared with men, with an intermediate MACE between those with obstructive CAD and no CAD. In contrast, men with nonobstructive CAD had a prognosis similar to men with no CAD in the first year. Although these sex differences lessened with longer term follow-up, women with nonobstructive CAD remained at higher risk compared with men (Figure 2).
(Enlarge Image)
Figure 2.
Freedom from MACE grouped by sex and CAD status.
To further understand the MACE rates over time, HRs by CAD status and sex were estimated separately for the first year and for 1 to 3 years postcatheterization and are shown in Table IV.
Short-term MACE in Nonobstructive and No CAD. Women with nonobstructive CAD were at a higher risk for MACE than men with nonobstructive CAD, in the first year postcatheterization in both unadjusted and adjusted models (Table IV). In contrast, there was no significant difference in the risk of MACE in women compared with men with no CAD, in the first year postcatheterization. When examining each sex separately by CAD extent, women with nonobstructive CAD had a higher unadjusted and adjusted risk of MACE than those with no CAD (Table IV). In contrast, men with nonobstructive CAD were at a similar risk for MACE as those with no CAD.
Longer Term MACE in Nonobstructive and No CAD. The cumulative MACE rate in the nonobstructive CAD group remained higher than the no CAD group and lower than the obstructive CAD group over the entire follow-up period. However, the risk of MACE observed 1 to 3 years post index catheterization was not significantly different among the no and nonobstructive CAD groups after adjustment, irrespective of sex as shown in Table IV.
Major Adverse Cardiac Event Without HF.Table V demonstrates the HR for MACE without HF. Several notable differences were observed when compared with MACE with HF. Specifically, the HR between women versus men for the nonobstructive CAD group was no longer significant in either the unadjusted or adjusted model for the 1-year follow-up after catheterization. Furthermore, the HR for nonobstructive versus no CAD in women was significant for the unadjusted model for the first year but was no longer significant after adjustment.
Results
Baseline Characteristics
Coronary artery disease status by sex is presented in Table I. Of the 13,695 patients, most had obstructive CAD, a minority had non-obstructive CAD, and >15% had no CAD. More than one-third of women had no CAD compared with <10% of men. Women also had a significantly higher proportion of nonobstructive CAD compared with men. Table II summarizes the extent of single, double, and triple vessel CAD in the obstructive group by modified Duke criteria according to sex.
Baseline demographic and clinical characteristics for women and men by CAD status are presented in Table III. In the nonobstructive CAD category, women were older, had more hypertension, and more cancer but smoked less (all P < .001).
Major Adverse Cardiac Events by Sex and CAD Status
The Kaplan-Meier curves for freedom from MACE grouped by sex and CAD status are shown in Figure 2. In the first year after coronary angiography, women with nonobstructive CAD had a significantly worse prognosis compared with men, with an intermediate MACE between those with obstructive CAD and no CAD. In contrast, men with nonobstructive CAD had a prognosis similar to men with no CAD in the first year. Although these sex differences lessened with longer term follow-up, women with nonobstructive CAD remained at higher risk compared with men (Figure 2).
(Enlarge Image)
Figure 2.
Freedom from MACE grouped by sex and CAD status.
Major Adverse Cardiac Events in the Short and Long Terms
To further understand the MACE rates over time, HRs by CAD status and sex were estimated separately for the first year and for 1 to 3 years postcatheterization and are shown in Table IV.
Short-term MACE in Nonobstructive and No CAD. Women with nonobstructive CAD were at a higher risk for MACE than men with nonobstructive CAD, in the first year postcatheterization in both unadjusted and adjusted models (Table IV). In contrast, there was no significant difference in the risk of MACE in women compared with men with no CAD, in the first year postcatheterization. When examining each sex separately by CAD extent, women with nonobstructive CAD had a higher unadjusted and adjusted risk of MACE than those with no CAD (Table IV). In contrast, men with nonobstructive CAD were at a similar risk for MACE as those with no CAD.
Longer Term MACE in Nonobstructive and No CAD. The cumulative MACE rate in the nonobstructive CAD group remained higher than the no CAD group and lower than the obstructive CAD group over the entire follow-up period. However, the risk of MACE observed 1 to 3 years post index catheterization was not significantly different among the no and nonobstructive CAD groups after adjustment, irrespective of sex as shown in Table IV.
Major Adverse Cardiac Event Without HF.Table V demonstrates the HR for MACE without HF. Several notable differences were observed when compared with MACE with HF. Specifically, the HR between women versus men for the nonobstructive CAD group was no longer significant in either the unadjusted or adjusted model for the 1-year follow-up after catheterization. Furthermore, the HR for nonobstructive versus no CAD in women was significant for the unadjusted model for the first year but was no longer significant after adjustment.
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