Table 2

Summary of Studies for Sex-Based Differences in Vessel Size, Plaque Burden, and Morphology

First Author, Year (Ref. #)Imaging UsedSample SizePatient PopulationMain Findings
Vessel size
Kornowski et al., 1997 (17)Angiography, IVUSN = 718
(23.5% women)
Patients with chronic anginaWomen had smaller vessel sizes than men. However, no differences were demonstrable when adjusted for BSA. Differences related to target vessel location and segment were not accounted for.
Kucher et al., 2001 (19)Trans-esophageal echoN = 200
(50% women)
Patients undergoing trans-esophageal echoWomen had smaller vessel size when adjusted for left ventricular mass.
Kim et al., 2004 (18)Angiography, IVUSN = 257
(45.1% women)
Patients with pre-interventional IVUS including the left mainSex and BSA independently influenced the size of the left main.
Sheifer et al., 2000 (20)Angiography, IVUSN = 75
(33.3% women)
Consecutive patients undergoing angiography and IVUS of the left main or LADWomen had smaller vessel size adjusted for age, hypertension and plaque size.
Wykrzykowska et al., 2012 (22) (PROSPECT trial)IVUSN = 697
(25% women)
Patients presenting with ACS.Except for the left main, women had smaller vessel sizes compared with men.
Plaque burden and morphology
Lansky et al., 2012 (26) (PROSPECT trial substudy)Angiography, IVUS, IVUS-VHN = 697
(25% women)
Patients presenting with ACS. Assessment of culprit and non-culprit lesions by sex.Culprit lesions:
Similar distribution, number and complexity of culprit lesions in men and women.
Nonculprit lesions:
Women have fewer NCL, more focal NCL, greater prevalence of MLA <4 mm2, similar prevalence of PB ≥70% and TCFA in NCL.
No difference in NCL-MACE was detected at 3.4 years in men versus women.
Chia et al., 2007 (27)OCTN = 42
(21.4% women)
Stable populationSimilar prevalence of lipid-rich plaques, TCFA, minimal fibrous cap thickness, number of plaques with disruption, calcification, or thrombus in men and women.
Guagliumi et al., 2014 (28) (OCTAVIA study)OCTN = 140 men, N = 140 womenSTEMI, Matched analysis,
Assessment of culprit lesions by sex
Men and women had similar prevalence of plaque rupture (50.0% vs. 48.4%, p = 0.56) and erosion (∼25%, p = 0.84).
At 9 months strut coverage and rate of neointimal obstruction (10.3% vs. 10.6%; p = 0.76) was similar.
Effect of age and sex
Ruiz-Garcia et al., 2012 (29) (PROSPECT trial substudy)Angiography, IVUS, IVUS-VH<65 years of age:
N = 486 (18.1% women);
≥65 years of age:
N = 211 (37.4% women)
Patients presenting with ACS: Assessment of nonculprit lesions by age and sex<65 years of age, NCL:
Women had fewer NCL per patient, smaller plaque volume, less plaque rupture, more fibrous plaques and fewer FAs than men
≥65 years of age, NCL:
No differences by sex were observed in NCL plaque volume, prevalence of plaque rupture, fibrotic plaques and FAs.
Schoenenberger et al., 2013 (30)IVUSN = 390 patients (27.6% women)ACS and non-ACS patients presenting for coronary angiography,
Assessment of culprit and nonculprit lesions by age tertiles and sex
Nonculprit lesions:
NCL PB increases with age in both men and women.
Men did not demonstrate significant changes in NCL plaque characteristics across the age tertiles. In women there was an increase in necrotic core and fibrous tissue with age resulting in similar morphology to men.
Culprit lesions:
Within each age tertile, culprit PB was similar in both men and women.
Plaque morphology in culprit vessels of women and men in the lowest tertile was similar. In contrast, in the highest tertile, culprit vessels in men were more rupture-prone demonstrating greater prevalence of necrotic core and dense calcium compared with women.
Qian et al., 2009 (31) (IVUS-VH Registry)IVUS-VHN = 990
(24.5% women)
ACS and non-ACS population: Vessel segments imaged using IVUS were analyzed – including culprit, nonculprit, treated and nontreated arteries.In both men and women, PB, necrotic core and dense calcium increased with age.
At any age men had greater PB than women.
Sex differences were lowest in the oldest age tertile.
Pundziute et al., 2010 (32)64 slice MSCT, IVUSN = 93
(36.6% women)
Stable population with chest pain suggestive of CAD<65 years of age:
Men demonstrated more obstructive and nonobstructive plaques on MSCT vs. women.
Men had higher median coronary calcium score than women.
On grayscale IVUS, men had greater PB, plaque volume and calcium arc compared with women.
On IVUS-VH, men had greater prevalence of TCFA and women had more fibrotic plaques.
≥65 years of age:
Men had more obstructive but not nonobstructive plaques than women, and greater plaque volume on IVUS in the most diseased portion.
On IVUS-VH men had more fibrofatty plaques compared with women but similar TCFA.

ACS = acute coronary syndrome; BSA = body surface area; CAD = coronary artery disease; CI = confidence interval; FA = fibroatheroma; HR = hazard ratio; IVUS = intravascular ultrasound; MSCT = multislice computed tomography; MLA = minimal lumen area; NCL = nonculprit lesions; OCT = optical coherence tomography; PB = plaque burden; STEMI = ST-segment elevation myocardial infarction; TCFA = thin-cap fibroatheroma; VH = virtual histology.