Abstract
Background
Women consistently have poorer revascularization outcomes and more coronary vascular complications compared to men. This has been attributed to smaller coronary arteries, though limited data exist to support this assumption.
Hypothesis
By using volumetric data obtained from multidetector cardiovascular computed tomography (CCT), we sought to determine to what extent gender influences coronary artery dimensions and test the hypothesis that women would have smaller coronary dimensions even after normalizing for body surface area and cardiac mass.
Methods
CCT examinations completed on a 64‐slice scanner were identified from a university cardiovascular database. Data sets from 50 women and 44 men without coronary artery disease were selected for analysis. Cross‐sectional areas of proximal and distal segments of the left anterior descending (LAD), circumflex (LCx), and right coronary artery (RCA) were measured, blinded to patient gender. Measurements were compared using 2‐sample t tests and linear regression analysis techniques accounting for body surface area (BSA) and left ventricular (LV) mass.
Results
Analysis of cross‐sectional coronary artery areas, unadjusted for BSA and LV mass showed smaller coronary artery size in women compared to men in the proximal portion of both the LAD (P = .01) and RCA (P = .002), but no significant difference in the remaining coronary segments.
Conclusion
Gender significantly impacts proximal LAD and RCA size. Differences in coronary artery dimensions may explain some, but not all excess gender‐related risk with coronary artery revascularization, underscoring the importance of considering multiple contributing factors. Copyright © 2010 Wiley Periodicals, Inc.
Keywords: computed tomography, gender, coronary angiography, coronary artery disease
Full Text
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References
- 1. Abramov D, Tamariz MG, Sever JY, et al. The influence of gender on the outcome of coronary artery bypass surgery. Ann Thorac Surg 2000; 70: 800–805. [DOI] [PubMed] [Google Scholar]
- 2. Aguilar MD, Lazaro P, Fitch K, Luengo S. Gender differences in clinical status at time of coronary revascularisation in Spain. J Epidemiol Community Health 2002; 56: 555–559. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Kim C, Redberg RF, Pavlic T, Eagle KA. A systematic review of gender differences in mortality after coronary artery bypass graft surgery and percutaneous coronary interventions. Clin Cardiol 2007; 30: 491–495. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Argulian E, Patel AD, Abramson JL, et al. Gender differences in short‐term cardiovascular outcomes after percutaneous coronary interventions. Am J Cardiol 2006; 98: 48–53. Epub May 4, 2006. [DOI] [PubMed] [Google Scholar]
- 5. Berger JS, Brown DL. Gender‐age interaction in early mortality following primary angioplasty for acute myocardial infarction. Am J Cardiol 2006; 98: 1140–1143. Epub August 31, 2006. [DOI] [PubMed] [Google Scholar]
- 6. Cantor WJ, Miller JM, Hellkamp AS, et al. Role of target vessel size and body surface area on outcomes after percutaneous coronary interventions in women. Am Heart J 2002; 144: 297–302. [DOI] [PubMed] [Google Scholar]
- 7. Blankstein R, Ward RP, Arnsdorf M, Jones B, Lou YB, Pine M. Female gender is an independent predictor of operative mortality after coronary artery bypass graft surgery: contemporary analysis of 31 Midwestern hospitals. Circulation 2005; 112: I323–I327. [DOI] [PubMed] [Google Scholar]
- 8. Edwards ML, Albert NM, Wang C, Apperson‐Hansen C. 1993–2003 gender differences in coronary artery revascularization: has anything changed? J Cardiovasc Nurs 2005; 20: 461–467. [DOI] [PubMed] [Google Scholar]
- 9. Guru V, Fremes SE, Austin PC, Blackstone EH, Tu JV. Gender differences in outcomes after hospital discharge from coronary artery bypass grafting. Circulation 2006; 113: 507–516. [DOI] [PubMed] [Google Scholar]
- 10. Edwards FH, Carey JS, Grover FL, Bero JW, Hartz RS. Impact of gender on coronary bypass operative mortality. Ann Thorac Surg 1998; 66: 125–131. [DOI] [PubMed] [Google Scholar]
- 11. Glaser R, Selzer F, Jacobs AK, et al. Effect of gender on prognosis following percutaneous coronary intervention for stable angina pectoris and acute coronary syndromes. Am J Cardiol 2006; 98: 1446–1450. [DOI] [PubMed] [Google Scholar]
- 12. Kim SG, Apple S, Mintz GS, et al. The importance of gender on coronary artery size: in‐vivo assessment by intravascular ultrasound. Clin Cardiol 2004; 27: 291–294. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Sheifer SE, Canos MR, Weinfurt KP, et al. Sex differences in coronary artery size assessed by intravascular ultrasound. Am Heart J 2000; 139: 649–653. [DOI] [PubMed] [Google Scholar]
- 14. Nissen SE. Application of intravascular ultrasound to characterize coronary artery disease and assess the progression or regression of atherosclerosis. Am J Cardiol 2002; 89: 24B–31B. [DOI] [PubMed] [Google Scholar]
- 15. Yang F, Minutello RM, Bhagan S, Sharma A, Wong SC. The impact of gender on vessel size in patients with angiographically normal coronary arteries. J Interv Cardiol 2006; 19: 340–344. [DOI] [PubMed] [Google Scholar]
- 16. Dodge JT Jr, Brown BG, Bolson EL, Dodge HT. Lumen diameter of normal human coronary arteries. Influence of age, sex, anatomic variation, and left ventricular hypertrophy or dilation. Circulation 1992; 86: 232–246. [DOI] [PubMed] [Google Scholar]
- 17. Kucher N, Lipp E, Schwerzmann M, Zimmerli M, Allemann Y, Seiler C. Gender differences in coronary artery size per 100 g of left ventricular mass in a population without cardiac disease. Swiss Med Wkly 2001; 131: 610–615. [DOI] [PubMed] [Google Scholar]
- 18. Roberts CS, Roberts WC. Cross‐sectional area of the proximal portions of the three major epicardial coronary arteries in 98 necropsy patients with different coronary events. Relationship to heart weight, age and sex. Circulation 1980; 62: 953–959. [DOI] [PubMed] [Google Scholar]
- 19. Austen WG, Edwards JE, Frye RL, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 1975; 51: 5–40. [DOI] [PubMed] [Google Scholar]
- 20. Hassan A, Chiasson M, Buth K, Hirsch G. Women have worse long‐term outcomes after coronary artery bypass grafting than men. Can J Cardiol 2005; 21: 757–762. [PubMed] [Google Scholar]
- 21. Tremmel JA, Yeung AC. Ischemic heart disease in women: an appropriate time to discriminate. Rev Cardiovasc Med 2007; 8: 61–68. [PubMed] [Google Scholar]
- 22. Edwards FH, Ferraris VA, Shahian DM, et al. Gender‐specific practice guidelines for coronary artery bypass surgery: perioperative management. Ann Thorac Surg 2005; 79: 2189–2194. [DOI] [PubMed] [Google Scholar]
- 23. Humphries KH, Gao M, Pu A, Lichtenstein S, Thompson CR. Significant improvement in short‐term mortality in women undergoing coronary artery bypass surgery (1991 to 2004). J Am Coll Cardiol 2007; 49: 1552–1558. Epub 2007 March 26, 2007. [DOI] [PubMed] [Google Scholar]
- 24. Limbruno U, De Caterina R. Vasomotor effects of iodinated contrast media: just side effects? Curr Vasc Pharmacol 2003; 1: 321–328. [DOI] [PubMed] [Google Scholar]
- 25. Bairey Merz CN, Shaw LJ, Reis SE, et al. Insights from the NHLBI‐Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender‐based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol 2006; 47: S21–S29. [DOI] [PubMed] [Google Scholar]
- 26. Handberg E, Johnson BD, Arant CB, et al. Impaired coronary vascular reactivity and functional capacity in women: results from the NHLBI Women's Ischemia Syndrome Evaluation (WISE) Study. J Am Coll Cardiol 2006; 47: S44–S49. [DOI] [PubMed] [Google Scholar]
- 27. Marroquin OC, Kip KE, Mulukutla SR, et al. Inflammation, endothelial cell activation, and coronary microvascular dysfunction in women with chest pain and no obstructive coronary artery disease. Am Heart J 2005; 150: 109–115. [DOI] [PubMed] [Google Scholar]