L’angioplastica coronarica nella donna: fattori di rischio e differenze dell’anatomia coronarica legate al sesso valutate con ecografia intravascolare [Coronary angioplasty in women: risk factors and sex-related differences in coronary anatomy evaluated with intravascular ultrasonography.]

BACKGROUND: The aim of this study was to evaluate the risk factors for cardiovascular diseases, clinical presentation and coronary anatomical size differences in women. METHODS: From January 1999 to December 2000, 244 female and 980 male patients were submitted to coronary angioplasty (PTCA). For both groups the following were considered: risk factors for cardiovascular diseases, clinical presentation and angiographic data. The clinically confirmed 6 months restenoses were evaluated. We performed intravascular ultrasound (IVUS) with three-dimensional reconstruction and quantitative coronary angiography (QCA) on the proximal left anterior descending (LAD) coronary artery segments free of significant atherosclerosis in 60 men and 50 women matched for age and clinical characteristics. The arterial and luminal areas were measured by planimetry and corrected for body surface area. We also evaluated the external elastic membrane diameter (EEMd), the minimal lumen diameter (MLD) and the intima-media thickness (IMT). RESULTS: At the time of admission, women were older than men, were shorter, weighed less, and had a smaller body surface area; they had more severe angina, diabetes mellitus and hypercholesterolemia. There was no difference between women and men in the incidence of clinical restenosis at 6 months of follow-up. At IVUS, the mean uncorrected LAD arterial area was smaller in women than in men (12.7 +/- 3 vs 15.9 +/- 3.3 mm2, p < 0.05), as was the mean LAD luminal area (9.9 +/- 3 vs 12.9 +/- 2.7 mm2, p < 0.005). Both the MLD and the EEMd as well as the IMT were smaller in women than in men (MLD 3.3 +/- 0.6 vs 3.9 +/- 0.5 mm, p < 0.05; EEMd 3.7 +/- 0.6 vs 4.2 +/- 0.4 mm, p < 0.005; IMT 0.29 +/- 0.1 vs 0.4 +/- 0.1 mm, p < 0.05). QCA confirmed the IVUS results (MLD 2.9 +/- 0.6 vs 3.5 +/- 0.8 mm, p < 0.05). After correction for body surface area, univariate associations between sex and both the arterial and luminal areas were no longer present. CONCLUSIONS: Women submitted to PTCA were older. The incidence of hypertension, diabetes mellitus and hypercholesterolemia was higher than in men. There was no sex difference in the rate of clinical restenosis at 6 months of follow-up. The LAD artery is smaller in women, independently of body size. This suggests an intrinsic sex effect on coronary dimensions.