Sex differences of clinical outcomes in patients undergoing percutaneous coronary intervention: a nationwide cohort...

Sex differences in outcomes after percutaneous coronary intervention (PCI) remain debated, and evidence from large Asian populations is limited.

We analyzed 136 109 patients (101 301 men; 34 808 women) without prior major cardiovascular events who underwent PCI between 2004 and 2020, using data from the Korean National Health Insurance Service. Baseline characteristics, in-hospital events, and long-term clinical outcomes were compared. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, nonfatal myocardial infarction, repeat PCI, coronary artery bypass surgery, and ischemic stroke.

Women were older and had higher rates of hypertension and diabetes, whereas men had higher smoking and alcohol consumption rates. In-hospital adverse events, including death, ischemic stroke, and bleeding were more frequent in women (P < 0.001). However, during a mean follow-up of 3.1 years, women had a lower incidence of MACE compared to men (58.0 vs. 65.3%; P < 0.001). Multivariable Cox regression confirmed that female sex was independently associated with a lower long-term risk of MACE (adjusted hazard ratio: 0.69-0.82, P < 0.001).

Despite worse in-hospital outcomes, women had a more favorable long-term prognosis after PCI compared to men. These findings emphasize the importance of sex-specific approaches in risk assessment and long-term management after PCI.