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Sex Differences in Patients Undergoing Left Main Stem Percutaneous Coronary Intervention for Stable Angina: Data From
Warkaa Shamkhani1,2,3, Zafraan Zathar3, Sophia Khattak3
1Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences Keele University Stoke-on-Trent United Kingdom.
Insights
Women undergoing left main coronary artery (LMCA) percutaneous coronary intervention (PCI) for stable angina face higher mortality and major bleeding risks, despite fewer comorbidities. A sex-tailored approach is recommended for improved outcomes in LMCA PCI.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Outcomes Research
Background:
- Percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) disease in stable angina is increasing.
- Limited data exists on sex-based differences in clinical outcomes following LMCA PCI.
- Assessing sex-specific trends and outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate sex-based trends and differences in clinical outcomes among patients with stable angina undergoing LMCA PCI.
- To identify potential factors contributing to disparities in outcomes between men and women.
- To inform sex-tailored strategies for improving LMCA PCI results.
Main Methods:
- Retrospective analysis of UK national PCI registry data (2006-2022) for stable angina patients undergoing LMCA PCI.
- Inpatient mortality, major bleeding, and major cardiovascular and cerebral events were primary and secondary outcomes.
- Multivariate logistic regression was used to determine adjusted odds ratios for outcomes, controlling for patient characteristics.
Main Results:
- Out of 24,271 LMCA PCI procedures, 22.7% were performed in women, who were older and had lower comorbidity burden.
- Women experienced significantly higher adjusted odds of inpatient mortality (aOR, 1.63) and major bleeding (aOR, 2.07).
- While major cardiovascular and cerebral events were higher in women, the difference was not statistically significant (aOR, 1.27).
Conclusions:
- Women undergoing LMCA PCI have worse outcomes, including increased mortality and major bleeding, even with fewer comorbidities.
- Age, intravascular imaging use, and vascular access strategies may influence sex-based outcome differences.
- A sex-tailored approach is necessary to improve clinical outcomes for women undergoing LMCA PCI.
Background:
Percutaneous coronary intervention (PCI) of the left main coronary artery (LMCA) for stable angina has steadily increased. Outcomes stratified by sex are inconclusive and limited. We assessed sex-based trends and differences in clinical outcomes among patients with stable angina who received LMCA PCI.
Methods And Results:
We retrospectively collected data on patients with stable angina who underwent LMCA PCI (2006-2022) from the UK national PCI registry. The primary outcome of interest was inpatient mortality. Secondary outcomes were major bleeding and major cardiovascular and cerebral events. Multivariate logistic regression was used to assess adjusted odds ratio for outcome of interest. Of the 24 271 LMCA PCI performed, 5497 (22.7%) were in women. Women were older than men (median 72.7 versus 70.4) and less likely to have their PCI via radial access (50.3% versus 58.9%). More women had PCI guided by intravascular ultrasound (43.4% versus 41.2%). Women had significantly lower comorbid burden than men. Higher prevalence of chronic renal failure (6.72% versus 4.77%), smoking history (61.47% versus 45.68%), diabetes (27.36% versus 25.74%), prior myocardial infarction (45.36% versus 35.89%), and prior coronary artery bypass grafting (42.13% versus 30.34%) was observed in men than in women, respectively; P value <0.005 for all. Women had higher adjusted mortality (adjusted odds ratio, 1.63 [95% CI, 1.1-2.3]) and major bleeding events (adjusted odds ratio, 2.07 [95% CI, 1.19-3.59]). Although odds of major cardiovascular and cerebral events (adjusted odds ratio, 1.27[95% CI, 0.9-1.6]) were higher in women, it was not statistically significant.
Conclusions:
Despite being less comorbid, women had a significant increase in their mortality and major bleeding events following LMCA PCI. A sex-tailored approach considering age, intravascular imaging, and vascular access may improve outcomes.
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