Sex differences in treatment strategy for coronary artery aneurysms: Insights from the international Coronary Artery Aneurysm Registry

F Arslan, I J Núñez-Gil, R Rodríguez-Olivares, E Cerrato, M Bollati, L Nombela-Franco, B Terol, E Alfonso-Rodríguez, S J Camacho Freire, P A Villablanca, I J Amat Santos, J M De la Torre Hernández, I Pascual, C Liebetrau, M Alkhouli, A Fernández-Ortiz, Coronary Artery Aneurysm Registry (CAAR) investigators, F Arslan, I J Núñez-Gil, R Rodríguez-Olivares, E Cerrato, M Bollati, L Nombela-Franco, B Terol, E Alfonso-Rodríguez, S J Camacho Freire, P A Villablanca, I J Amat Santos, J M De la Torre Hernández, I Pascual, C Liebetrau, M Alkhouli, A Fernández-Ortiz, Coronary Artery Aneurysm Registry (CAAR) investigators

Abstract

Introduction: Sex disparities exist in coronary artery disease (CAD) in terms of risk profile, clinical management and outcome. It is unclear if differences are also present in coronary aneurysms, a rare variant of CAD.

Methods: Patients were selected from the international Coronary Artery Aneurysm Registry (CAAR; ClinicalTrials.gov: NCT02563626), and differences between groups were analysed according to sex. The CAAR database is a prospective multicentre registry of 1565 patients with coronary aneurysms (336 females). Kaplan-Meier method was used for event-free survival analysis for death, major adverse cardiac events (MACE: composite endpoint of death, heart failure and acute coronary syndrome) and bleeding.

Results: Female patients were older, were more often hypertensive and less frequently smoker. They were treated conservatively more often compared to male patients and received significantly less frequently aspirin (92% vs 88%, p = 0.002) or dual antiplatelet therapy (DAPT) (67% vs 58%, p = 0.001) at discharge. Median DAPT duration was also shorter (3 vs 9 months, p = 0.001). Kaplan-Meier analysis revealed no sex differences in death, MACE or bleeding during a median follow-up duration of 37 months, although male patients did experience acute coronary syndrome (ACS) more often during follow-up (15% vs 10%, p = 0.015).

Conclusions: These CAAR findings showed a comparable high-risk cardiovascular risk profile for both sexes. Female patients were treated conservatively more often and received DAPT less often at discharge, with a shorter DAPT duration. ACS was more prevalent among male patients; however, overall clinical outcome was not different between male and female patients during follow-up.

Keywords: Coronary artery aneurysms; Dual antiplatelet therapy; Sex.

Conflict of interest statement

F. Arslan, I. J. Núñez-Gil, R. Rodríguez-Olivares, E. Cerrato, M. Bollati, L. Nombela-Franco, B. Terol, E. Alfonso-Rodríguez, S. J. CamachoFreire, P. A. Villablanca, I. J. Amat Santos, J. M. De la Torre Hernández, I. Pascual, C. Liebetrau, M. Alkhouli and A. Fernández-Ortiz declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves for event-free survival from a death, b major adverse cardiac events (MACE) and c bleeding

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Source: PubMed

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