Long-term Follow-up of Patients with Coronary Artery Disease Undergoing Medical Treatment: A Sex-Specific Analysis

Background While sex-based differences in coronary artery disease (CAD) are well-recognized, data on long-term outcomes for patients managed with medical therapy alone, without revascularization, remain limited. This study aimed to investigate sex-specific differences in risk profiles, long-term mortality, and major adverse cardiovascular events (MACE) in a large cohort of patients with angiographically confirmed CAD undergoing medical treatment. Methods This retrospective cohort study included 2,050 patients (697 women, 1,353 men) with angiographically confirmed CAD (≥ 50% stenosis in at least one major vessel) who were managed medically at the Tehran Heart Center. Baseline demographic, clinical, and angiographic data were collected. Patients were followed for a median of 10.6 years to assess the primary outcomes of all-cause mortality and MACE (a composite of myocardial infarction, stroke, coronary revascularization, or death). Sex-stratified Cox proportional hazards models were used to identify independent predictors for each outcome. Results At baseline, women were older and had a significantly higher prevalence of diabetes, hypertension, and hyperlipidemia. Conversely, men had markedly higher rates of smoking and opium use. Over the follow-up period, Kaplan-Meier analysis showed that men had a higher cumulative hazard of mortality, whereas women had a higher cumulative hazard of MACE. In multivariable analysis, significant predictors of mortality in both sexes included advanced age, three-vessel disease, diabetes, and renal failure. Sex-specific predictors of mortality included peripheral vascular disease (stronger risk in women), a protective effect of family history of CAD (in women), and COPD and opium use (in men). For MACE, multi-vessel disease was a significant predictor in both sexes, while hypertension and prior cerebrovascular accident were independent predictors only in men. Conclusions In patients with established CAD managed medically, there are significant sex-specific differences in baseline risk profiles and long-term outcomes. Men face a higher risk of all-cause mortality, while women experience a greater burden of non-fatal cardiovascular events. These findings underscore the necessity of incorporating sex-aware strategies into the risk stratification and long-term management of coronary artery disease.