Women undergoing coronary angiography have less extensive coronary artery disease than men, but a similar cardiovascular death rate

Purpose: Coronary angiography has been used to predict the risk of cardiovascular death in patients with known or suspected coronary artery disease. However, the implication of coronary artery disease may differ between sexes. We set out to compare the cardiovascular mortality rate between men and women in relation to the extent of coronary artery disease. Methods: During an eight year period (1990-1998) we consecutively performed 2582 coronary angiograms on 2253 patients. The result of the first angiogram for each patient was graded as nonsignificant (<50% stenosis) or significant (>50% stenosis or occlusion) coronary disease in each of the 3 main arteries and their epicardial branches. Results: There were 1572 (69.8%) male and 681 (30.2%) female patients. The mean age was 60.6±10.1 years and did not differ between sexes. The mean follow-up time was 3.9±2.2 years. The overall rate of cardiovascular mortality was 5% and did not differ significantly between men (5.3%) and women (4.1%). Female patients had less advanced coronary artery disease with 47.1% having no significant coronary stenoses as compared to 21.4% of the male patients (p<0.001) (table). Among these, female and male patients had a cardiovascular mortality rate of 0.3% and 2.7% respectively (p<0.05). The proportion of patients with 3 vessel disease (VD) or left main stem disease (LMS) was higher among male (31.2%) than female (14.4%) patients. Among these patients with advanced coronary disease, female patients had a higher cardiovascular mortality rate (20.4%) than men (10.0%)(p<0.001). Not significant 1 VD 2 VD 3 VD LMS Total Men, % 2L4 25! 225 243 O 100 Women, % 47.1 23.9 14.5 11.6 2.8 100 Total, % 29.2 25.0 19.8 20.6 5.5 100 Conclusions: In an unselected cohort of patients undergoing coronary angiography, women had less extensive coronary artery disease than men. However, when present, advanced coronary artery disease indicated a higher risk of cardiovascular death among women than men.