Sex Differences in Clinical Outcomes After Bifurcation Percutaneous Coronary Intervention: Findings from the...

Sex differences in the outcomes of bifurcation percutaneous coronary intervention (PCI) have received limited study. We compared the procedural characteristics and outcomes between women and men in bifurcation PCI. Two thousand four hundred thirty-one patients who underwent bifurcation PCI at 7 centers between 2013 and 2025 from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions were studied. Of the study population, 25.3% (n = 615) were women. Women were older (68.2 ± 11.9 vs 65.6 ± 16.3 years; p <0.001), had higher prevalence of diabetes mellitus (48.8% vs 33.5%; p <0.001), hypertension (84.2% vs 76.9%; p <0.001), and higher rates of moderate or severe proximal main vessel calcification (40.2% vs 32.4%; p <0.001) compared with men. Use of provisional stenting (63.2% vs 64.0%, p = 0.694) and two-stent techniques (31.3% vs 30.3%, p = 0.653) was similar between groups. Technical success was comparable (93.7% vs 95.4%; p = 0.075), but women had lower procedural success (88.5% vs 93.2%; p <0.001) due to higher in-hospital major adverse cardiovascular events (MACE) (6.0% vs 2.7%; p <0.001), including in-hospital mortality (2.8% vs 1.0%; p = 0.001), stroke (1.3% vs 0.2%; p = 0.003), and procedural bleeding (1.0% vs 0.2%; p = 0.010). On multivariable analysis, female sex was independently associated with higher in-hospital MACE (odds ratio 2.99; 95% confidence intervals 1.69 to 5.29; p <0.001). During a median follow-up of 2.6 years, female sex was independently associated with long-term MACE (adjusted hazard ratio 1.32; 95% confidence intervals 1.04 to 1.67; p = 0.011). In conclusion, compared with men, bifurcation PCI in women is associated with similar technical success but higher in-hospital and adjusted follow-up MACE.