Abstract 5099: Extent and Severity of Coronary Stenosis at Autopsy Varies by Sex in Fatal Cases of Coronary Heart Disease
Background: Recently, the decline in mortality from coronary heart disease (CHD) has slowed in younger age groups, particularly young women. Young women with acute coronary syndromes (ACS) less often have obstructive CHD at angiography. This could reflect pre-hospital death of women with the most severe disease.
Hypothesis: There is a sex difference in extent and severity of coronary stenosis on post-mortem evaluation of people who died of CHD.
Methods: Reports of NYC medical examiner autopsies conducted on women 21–54 from1/1/06 –12/31/07 were reviewed if CHD was a cause of death (COD) and cocaine toxicology was negative. Women with CHD as immediate COD were matched by age and race to males with CHD as immediate COD. We analyzed severity of coronary stenosis based on the standard definition of “significant” CHD: ≥75% cross sectional area [CSA] stenosis in a major epicardial vessel, corresponding to 50% angiographic diameter stenosis, or ≥50% CSA stenosis in the left main. We assigned coronary jeopardy scores based on the number of obstructed segments. Statistical analysis was conducted by t-test and chi-square.
Results: Among 112 women with CHD as the immediate or contributing COD, 24 had immediate COD that were not obviously related to CHD (pneumonia, intoxication, etc). 84 cases with CHD as immediate COD were matched to men. Women were less likely to have “significant” coronary stenosis than men (68% vs. 87%, p=0.006). Among decedents with single-vessel CHD, the RCA was affected more often in women and the LAD in men. Jeopardy scores were lower in women but there was no sex difference in frequency of gross myocardial findings consistent with scarring (21% vs. 32% of men, p=0.16).
Conclusion: Young women determined at autopsy to have died of CHD exhibit significantly less extensive and severe coronary stenosis than men. These findings are consistent with angiographic findings in women with ACS. Mechanisms of death in these cases are unknown and may include spasm or arrhythmia.