Sex-Based Differences in Coronary Artery Anatomy and Clinical Outcomes in Acute Coronary Syndrome: A Multicenter Study from Tripoli, Libya

Abstract

Acute Coronary Syndrome (ACS) exhibits significant sex-based disparities in presentation, management, and outcomes. Understanding anatomical and clinical differences between men and women is essential for optimizing diagnostic and therapeutic strategies. This study aimed to identify sex-specific anatomical and clinical variations in ACS patients, evaluate their influence on diagnosis and management, and assess their impact on short-term outcomes. A retrospective descriptive study was conducted from June to October 2025 at Tajoura Cardiac Hospital and Al-Khadra Hospital, Tripoli, Libya. Medical records of 100 ACS patients were analyzed for demographics, comorbidities, presentation, coronary involvement, and outcomes. A survey of 20 cardiologists assessed recognition and application of sex-specific anatomical considerations. Of 100 patients, 67% were male and 33% female. Typical chest pain was more common in males (36%), while females more frequently reported dyspnea (70%). The left anterior descending artery was most commonly involved (48%), with males showing a higher prevalence of proximal lesions and STEMI (27% vs. 13%). Females more often presented with NSTEMI and diffuse, distal disease. In-hospital major adverse cardiac events occurred in 20% of patients, slightly higher in males. All surveyed cardiologists acknowledged the impact of sex-specific anatomy on outcomes; however, only 10% reported adjusting treatment strategies based on sex. Significant sex-based differences exist in ACS presentation and coronary anatomy. Males typically present with obstructive focal lesions and classic symptoms, while females exhibit diffuse disease, microvascular involvement, and atypical symptoms. Recognizing these variations is essential for developing tailored management approaches to improve outcomes for all patients.