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Sex Differences in State-of-the-Art Management for Left Main Disease

Takayuki Warisawa1, Christopher M Cook2, Yousif Ahmad3

  • 1Department of Cardiology, NTT Medical Center Tokyo, Tokyo, Japan; National Heart and Lung Institute, Imperial College London, London, United Kingdom.

JACC. Advances
|August 29, 2025
PubMed

Insights

Contemporary treatments for left main coronary artery disease (LMD) show similar outcomes for women and men. This study found no significant sex differences in major adverse cardiac events after state-of-the-art LMD revascularization.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Higher mortality in women undergoing coronary revascularization for left main coronary artery disease (LMD) is documented.
  • Contemporary management strategies' ability to mitigate these sex-based disparities remains unclear.

Purpose of the Study:

  • To investigate sex differences in outcomes for patients with LMD.
  • Utilize the DEFINE-LM registry, which employed state-of-the-art management.

Main Methods:

  • Analysis of 314 patients from an international, multicenter registry (65 women, 249 men).
  • All patients received advanced care: physiology-guided revascularization, imaging-optimized stent deployment, or surgical procedures with internal thoracic artery grafts, plus guideline-directed medical therapy.
  • Primary endpoint: composite of death, myocardial infarction (MI), or ischemia-driven target lesion revascularization (TLR) of the left main stem (LM-TLR).

Main Results:

  • Women were significantly older (70.1 vs 67.6 years).
  • At 30 months, the primary endpoint occurred in 13.8% of women vs 11.2% of men (Hazard Ratio [HR]: 1.15; P=0.71).
  • No significant sex differences were observed for secondary endpoints, including cardiac death/MI or LM-TLR, even after adjusting for age.

Conclusions:

  • State-of-the-art management for LMD revascularization resulted in comparable outcomes for women and men.
  • Age was a factor, but sex did not independently predict outcomes in this cohort.
Abstract

Keywords:
coronary physiologyleft main coronary artery diseaseoutcomeswomen

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