Sex-Specific Differences in Coronary Artery Dimensions and Tapering: A Sudanese Angiographic Study

Abstract Introduction Sex-specific anatomical variations in coronary arteries influence procedural outcomes, yet data from the African population remain scarce. Existing benchmarks are largely derived from Western and male-dominant populations. This study aims to provide a comparative morphometric analysis of the LAD and LCX in a Sudanese cohort, highlighting sex-specific differences in tapering, diameters, and lengths. Method This multicentre retrospective study analyzes 357 coronary angiograms (147 males, 210 females) from three Sudanese cardiac centers (2018–2019) in patients with non-obstructive coronary artery disease (stenosis < 50%). Diameters of the left anterior descending (LAD) and left circumflex (LCX) arteries were measured at origin, mid, and terminal segments, along with total length including the left main coronary artery (LMCA). Measurements were normalized to body surface area (BSA). Tapering was expressed as a percentage reduction in the proximal-to-distal diameter. Sex differences were assessed using t-tests, ANOVA, and Pearson correlations, with additional analyses adjusted for age and BSA. Results LMCA diameter (3.8 ± 0.5 mm) did not differ by sex. Females had longer LADs (90.97 ± 25.62 mm vs. males: 76.6 ± 27.3 mm; P = 0.001). Females (50.1 ± 20.1%) have greater overall tapering than males (46.5 ± 18.2%), with a significant difference ( P = 0.0024). Diameter-length correlation for LAD was stronger in females ( r = 0.54 vs. males: r = 0.38; P = 0.001). LAD was longer than LCX (85.1 ± 27.2 mm vs. 67.3 ± 21.6 mm; P < 0.001), with females having wider proximal LAD (2.3 ± 0.64 mm vs. 2.14 ± 0.35 mm; P = 0.03). After adjustment for age and BSA, sex remained independently associated with LAD length and tapering. Overall vessel diameters were numerically smaller than values commonly reported in non-African populations. Conclusion Within the study cohort, significant sex-specific morphometric differences exist. Females have longer LADs (90.97 ± 25.62 mm vs. 76.6 ± 27.3 mm; P < 0.001), exhibit greater overall tapering (50.1 ± 20.1% vs. 46.5 ± 18.2%; P = 0.0024), and demonstrate a stronger diameter-length correlation ( r = 0.54 vs. 0.38; P = 0.001) than males, with sex remaining an independent predictor of LAD length and tapering after adjustment for age and body surface area. The LAD was longer than the LCX (85.1 ± 27.2 mm vs. 67.3 ± 21.6 mm; P < 0.001). Overall vessel diameters in this Sudanese cohort were numerically smaller than those reported in non-African populations, though a direct statistical comparison was not performed. These findings are descriptive and hypothesis-generating, suggesting that population- and sex-specific anatomical benchmarks warrant further investigation in prospective, outcome-based studies.