Gender differences in coronary artery diameter are not related to body habitus or left ventricular mass

Abstract

Background: Smaller coronary artery diameter portends worse outcomes after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). The suggestion that women have smaller coronary artery diameters than men has not been validated by a large-scale study.

Hypothesis: We sought to confirm a gender difference with respect to coronary artery diameter, even after accounting for body habitus and left ventricular mass (LVM).

Methods: From 4200 subjects evaluated for cardiovascular disease by computed tomography angiography, we selected 710 subjects (383 males, 327 females) with coronary artery calcium (CAC) scores <100, eliminating patients with artery remodeling. Diameters of the left main (LM), left anterior descending (LAD), left circumflex (CX), and right coronary arteries (RCA), were measured. Measurements were compared using a 2-sample t test and the multiple regression model, accounting for body habitus and LVM.

Results: After adjusting for age, race, weight, height, body mass index, body surface index, LVM, and CAC, women have smaller diameters in the LM (males 4.35 mm, females 3.91 mm), LAD (males 3.54 mm, females 3.24 mm), CX (males 3.18, females 2.75 mm), and RCA (males 3.70 mm, females 3.26 mm) (P < 0.001). This difference is not related to body habitus or LVM.

Conclusions: Gender significantly influences artery diameter of the LM, LAD, CX, and RCA. This may warrant gender specific approaches during PCI and CABG. As neither body habitus nor LVM relate to the difference in coronary artery diameter, our study encourages a search for inherent differences between genders that can account for this difference.

Figure 1

Coronary artery diameter measurements. Examples of coronary artery diameter measurements taken in the left main artery 10 mm before bifurcation (panel A, left) and the right coronary artery within the 10‐mm proximal segment (panel B, right) are shown. In a similar way, measurements are taken from the left anterior descending artery and the left circumflex artery (both within the proximal 10‐mm segment after bifurcation from the left main artery). The 3 measurements taken in each artery are averaged to produce the final diameter data for that particular coronary artery.