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Gender-related differences in clinical outcomes after either single or double left main bifurcation stenting

Gianluca Rigatelli1, Marco Zuin2, Claudio Picariello3

  • 1Division of Cardiology, Department of Specialistic Medicine, Rovigo General Hospital, Viale Tre Martiri 140, 45100, Rovigo, Italy. jackyheart@libero.it.

Heart and Vessels
|February 18, 2022
PubMed

Insights

This study found no gender differences in target lesion failure (TLF) after unprotected left main bifurcation stenting. However, female patients experienced more major bleeding with double stenting, highlighting a specific risk for women undergoing complex PCI.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Research
  • Clinical Outcomes Research

Background:

  • Unprotected left main (ULM) bifurcation lesions pose a significant challenge in percutaneous coronary intervention (PCI).
  • Understanding gender-specific outcomes in complex PCI is crucial for personalized treatment strategies.
  • Previous studies have shown varied results regarding gender disparities in cardiovascular interventions.

Purpose of the Study:

  • To investigate the impact of gender on clinical outcomes at 3-year follow-up in patients with ULM bifurcation disease.
  • To compare the role of double versus single stenting approaches in relation to gender and clinical outcomes.
  • To evaluate the association between gender and target lesion failure (TLF) based on different stenting techniques.

Main Methods:

  • Retrospective analysis of 567 patients (251 females) with complex ULM bifurcation disease treated between 2008 and 2018.
  • Utilized various stenting techniques: Crossover provisional, T or T-and-Protrusion (TAP), Culotte, and Nano-inverted-T (NIT).
  • Assessed procedural data, medical history, and clinical outcomes including TLF, cardiovascular mortality, and stent thrombosis at a mean 37.1-month follow-up.

Main Results:

  • No significant gender differences were observed in baseline characteristics or peri-procedural metrics.
  • The overall 3-year TLF rate was 12.1%, with cardiovascular mortality at 3.1% and stent thrombosis at 1.0%.
  • Female gender was associated with a higher rate of major bleeding when treated with a double stent strategy (p=0.02), but no gender difference in TLF was noted irrespective of the stenting approach.

Conclusions:

  • Gender does not appear to influence target lesion failure rates in patients undergoing PCI for ULM bifurcation disease, regardless of single or double stenting.
  • Female patients undergoing complex PCI for ULM bifurcation lesions may have an increased risk of major bleeding, particularly with double stenting.
  • These findings underscore the importance of considering gender-specific bleeding risks in the management of complex coronary artery disease.

Keywords:
Bifurcation stentingComplex bifurcationGenderLeft main

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