Sex-based Differences in Percutaneous Coronary Intervention Outcomes in Patients with Ischaemic Heart Disease
Antonia Sambola1,2,3, Bruno García Del Blanco1,2,3, Vijay Kunadian4,5
1Department of Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma Bellaterra, Spain.
Insights
Women with ischaemic heart disease receive percutaneous coronary intervention (PCI) less often than men. This review examines sex differences in PCI outcomes, considering patient factors and clinical scenarios.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Ischaemic heart disease is a leading cause of death globally.
- Women are less likely to receive guideline-recommended percutaneous coronary intervention (PCI) compared to men.
- Uncertainty exists regarding sex-based differences in PCI outcomes after accounting for clinical characteristics.
Purpose of the Study:
- To review recent evidence comparing PCI outcomes between men and women.
- To analyze sex differences in PCI outcomes across various clinical scenarios (ACS, stable angina, complex lesions).
- To assess the consideration of gender in current guidelines and provide clinical management insights for female patients.
Main Methods:
- Systematic review of published literature comparing male and female PCI outcomes.
- Focus on studies adjusting for clinical characteristics and comorbidities.
- Analysis of outcomes in specific scenarios like acute coronary syndromes and complex coronary artery interventions.
Main Results:
- Women undergoing PCI often present with higher comorbidity burdens and are older than men.
- Unadjusted outcomes for women undergoing PCI are frequently poorer.
- Evidence on sex-specific outcomes after risk adjustment is still evolving and requires further investigation.
Conclusions:
- Sex differences in percutaneous coronary intervention (PCI) outcomes persist, necessitating further research.
- Contemporary management strategies for female patients undergoing PCI require careful consideration of sex-specific factors.
- Guidelines should further address gender-specific nuances in cardiovascular care and interventional procedures.
Abstract:
In high-income countries, ischaemic heart disease is the leading cause of death in women and men, accounting for more than 20% of deaths in both sexes. However, women are less likely to receive guideline-recommended percutaneous coronary intervention (PCI) than men. Women undergoing PCI have poorer unadjusted outcomes because they are older and have greater comorbidity than men, but uncertainty remains whether sex affects outcome after these differences in clinical characteristics are considered. In this paper, we review recent published evidence comparing outcomes between men and women undergoing PCI. We focus on the sex differences in PCI outcomes in different scenarios: acute coronary syndromes, stable angina and complex lesions, including the approach of left main coronary artery. We also review how gender is considered in recent guidelines and offer a common clinical scenario to illustrate the contemporary management strategies an interventional cardiologist should consider when performing PCI on a female patient.
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