Gender Differences in Non-Obstructive Coronary Artery Disease

Abstract

: Subjects affected by ischemic heart disease with non-obstructive coronary arteries constitute a population that has received increasing attention over the past two decades. Since the first studies with coronary angiography, female patients have been reported to have non-obstructive coronary artery disease more frequently than their male counterparts, both in stable and acute clinical settings. Although traditionally considered a relatively infrequent and low-risk form of myocardial ischemia, its impact on clinical practice is undeniable, especially when it comes to infarction, where the prognosis is not as benign as previously assumed. Unfortunately, despite increasing awareness, there are still several questions left unanswered regarding diagnosis, risk stratification and treatment. The purpose of this review is to provide a state of the art and an update on current evidence available on gender differences in clinical characteristics, management and prognosis of ischemic heart disease with non-obstructive coronary arteries, both in the acute and stable clinical setting.

Symptomatology, prognosis and clinical findings of STEMI as a ramification of COVID-19: A systematic review and proportion meta-analysis

“…On the other hand, potential mechanisms of CAD could be worsened by COVID-19 infection including plaque disruption, dissection, thromboembolism, vasomotor and microvascular dysfunction, and supply/demand mismatch [ 14 , 15 , 24 , 26 ]. Interestingly, previous studies show that non-obstructive CAD is more commonly associated with women than men [ [28] , [29] , [30] ]. Consequently, the vast majority of people still present with MI and obstructive etiologies; simultaneously, the number of non-obstructive causes due to COVID-19 is increasing.…”

Update on Management of Cardiovascular Diseases in Women

“…The prevalence of INOCA ranged from 62% of 883 female patients undergoing coronary angiography in Women’s Ischemia Syndrome Evaluation to 34.4% of 1022 women referred to CT angiography in ISCHEMIA trial [ 164 ]. Because of the elevated risk for major adverse CV events, an early diagnosis and treatment should be made [ 165 ]. Furthermore, ischemia is often non-related to obstructive CAD in women, so imaging tools detecting coronary stenosis could be unsuitable, causing failure or delayed diagnosis.…”

Psychosocial distress and health status as risk factors for ten-year major adverse cardiac events and mortality in patients with non-obstructive coronary artery disease

“…However, most studies on adverse outcomes are done in patients with obstructive ischemic heart disease (IHD), having angina pectoris or an acute myocardial infarction, or who have undergone a percutaneous coronary intervention (PCI), or coronary artery bypass graft surgery (CABG). Studies in patients with non-obstructive IHD, which is more prevalent in women 9 , remain underrepresented.…”