Female Sex Is Independently Associated To Coronary Microvascular Dysfunction And Worse Myocardial Reperfusion After Percutaneous Coronary Interventions

Introduction: Improvements in ischemic heart disease (IHD) management have been unbalanced between sexes. Coronary microvascular dysfunction (CMD) is a putative reason for worse outcomes in women. Hypothesis: To explore sex and gender-sensitive determinants of CMD in IHD patients. Methods: The Endocrine Vascular disease Approach (EVA) is an ongoing monocentric observational study, aimed to assess sex- and gender-specific interactions between coronary circulation, hormonal status, and platelet function. Consecutive IHD patients undergoing urgent or elective angiography with or without percutaneous coronary interventions (PCI) were enrolled. CMD was assessed using myocardial blush grade (MBG). Baseline clinical, pharmacological and sociocultural parameters were recorded. Results: One hundred and sixty-three patients (mean age 67±11 years; 39% women) were analyzed. The referral reason for angiography was acute coronary syndrome in half cases, regardless sex. A previous IHD diagnosis was reported more frequently in men, women were less smokers, more frequently retired and widow, less adherent to medication therapy (all, p<0.05). The Duke Activity Status Index identified a worse performance status in women compared to men (28.2±18 vs 38.3±17, p=0.0002). The median in-hospital stay was longer in women (9 [6-17.5] vs 7 [4-12.5] days, p=0.032). CMD (defined by MBG<2) was significantly more frequently detected in women compared to men (48% vs 31%, p=0.034). Ischemia with no obstructive coronary disease was prevalent in women (40% vs 25%, p= 0.017). In the subgroup of patients undergoing PCI (n=68, 41.7%) the no achievement of optimal microvascular reperfusion (MBG=3), despite optimal restoration of epicardial flow, was higher in women compared to men (86% vs 56%, p=0.015). In the multiple regression analysis, only female sex was independently associated to CMD (OR 2.02, 95% CI 1.05-3.88, p=0.034) and to a MBG<3 after PCI (OR 4.88, 95% CI 1.26-18.7, p=0.022). Conclusions: Female sex is significantly associated with both CMD and worst myocardial perfusion after PCI. The further exploration of hormonal balance and platelet reactivity, as well as availability of outcomes data in the EVA cohort, will provide deepen insights to analyze this phenomenon.