Journal
INTERNATIONAL JOURNAL OF CARDIOLOGY
Volume 329, Issue -, Pages 67-73Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2020.11.067
Keywords
Sex; Complex PCI; Female; Coronary artery disease
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Despite presenting with more comorbidities, women undergoing CPCI had less complex coronary anatomy compared to men. However, women had a higher risk of myocardial infarction at one year post-CPCI.
Background: Although the number of complex percutaneous coronary intervention (CPCI) procedures is increasing. data regarding sex-related outcomes following CPCI are scarce. Methods: We retrospectively analyzed data of patients enrolled in a single-center registry between 2009 and 2017. Patients were divided into two groups (CPCI and non-CPCI) stratified by sex. CPCI was defined as any PCI procedure with 2.1 of the following characteristics: >= 3 target vessels/lesions, >= 3 stents implanted, bifurcation with >= 2 stents, stent length > 60 mm, or chronic total occlusion. The primary outcome was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), and target vessel revascularization, at oneon-year follow-up. Results: Among 20,419 patients, 5004 (24.5%) underwent CPCI of whom 25.6% (n = 1281) women and 74.4% (n = 3723) men. Women presented with more comorbidities yet less complex coronary anatomy than men (syntax score: 19.5 +/- 10.3 vs. 20.6 +/- 10.7,p = 0.009). Moreover, women were more likely to fulfill a single rather than multiple CPCI criteria. At one year, a higher rate of MACE occurred in women (14.0% vs. 11.6%, p - 0.02). After multivariable adjustment for confounders, the risk of MACE at one year was similar among both sexes ( HR:1.04, 95% CI [0.85-1.26], p = 0.71), without significant interaction between the complexity of the procedure and sex (p-interaction = 0.96). Nonetheless, the risk of MI was significantly higher in women than men undergoing CPCI (HR:1.63, 95% CI [1.12-2.38] p = 0.01). Conclusions: Despite presenting with less challenging lesions than men, women had a higher rate of MI at one year following CPCI, even after adjusting for potential confounders. (C) 2020 Elsevier B.V. All rights reserved.
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