Gender differences, age trends, and comorbidities impact on coronary artery stenosis severity and survival outcomes: a retrospective cohort study
F Khan, K Aslam, F Akbar, M WaleedAbstract
Background/Introduction
In coronary artery disease, stenosis burden and prognosis vary across patients, but in routine practice clinicians often have to act on incomplete risk stratification. We wanted an analysis that stays close to "what we actually see in the cath lab": angiographic stenosis severity in key segments, and survival differences by sex and common metabolic comorbidities.
Purpose
To quantify how gender, age, and hypertension, diabetes, and dyslipidaemia relate to coronary stenosis severity and survival in a large angiography cohort.
Methods
We analysed a retrospective cohort of 19,890 patients with angiographically diagnosed coronary artery disease who underwent coronary angiography between 1 January 2023 and 31 December 2024 at a single tertiary cardiac centre. Percent stenosis was extracted for the left main coronary artery and the left anterior descending artery (LAD) (proximal and mid–distal segments). Because our main decision question was "does stenosis location/severity and diabetes add prognostic information beyond age?", we used Kaplan–Meier curves for unadjusted survival comparisons and multivariable Cox regression to adjust for age and comorbidities. Sex comparisons of stenosis severity used independent t-tests. Statistical significance was set at p < 0.05, with hazard ratios and 95% confidence intervals reported.
Results
Stenosis severity showed a location-specific sex pattern rather than a uniform difference. Men had higher stenosis in the proximal LAD (80.1% vs 77.4%; p < 0.0001) and mid–distal LAD (78.9% vs 77.4%; p = 0.0245), while women had higher stenosis in the left main (66.6% vs 62.0%; p = 0.0127). Survival curves separated modestly but significantly: men had lower survival probability than women (log-rank p = 0.027). Comorbidity clustering marked a higher stenosis burden; for example, diabetes plus hypertension was associated with higher stenosis (proximal LAD 84.5%; p < 0.001). In the adjusted model, proximal LAD stenosis (hazard ratio 1.15, 95% confidence interval 1.08–1.23; p < 0.01) and diabetes (hazard ratio 1.20, 95% confidence interval 1.10–1.35; p < 0.05) independently predicted mortality. Here’s the trade-off: these associations are clinically usable for risk stratification, but the retrospective design means residual confounding cannot be fully excluded.
Conclusion
In a large angiography cohort, gender differences in stenosis were segment-specific (higher LAD stenosis in men, higher left main stenosis in women), and survival differed by sex. Diabetes and hypertension tracked with greater stenosis burden, and proximal LAD stenosis and diabetes independently predicted mortality after adjustment. These findings support personalised risk assessment that explicitly integrates stenosis location with comorbidity profile, while prospective studies with standardised follow-up should validate causality and refine risk thresholds.Stenosis Severity by artery and genderKaplan-Meier Curve for Male vs.female