Impact of sex on outcomes of bifurcation lesion percutaneous coronary intervention in a large single-centre prospective registry

Introduction

Coronary bifurcation lesions are associated with a lower procedural success rate and poorer clinical outcomes compared to non-bifurcation lesions. Sex-related differences in diagnostic and invasive therapeutic coronary procedures have been described in the literature. Our study aimed to assess the impact of sex on outcomes of bifurcation lesion percutaneous coronary intervention (PCI).

Material and Methods

Our data was taken from a prospective registry of consecutive patients undergoing PCI for bifurcation lesions at our medical center. We compared rates of death and major cardiac events (MACE: cardiac death, myocardial infarction, target vessel revascularization or CVA) at 1 year and 3 years. Cox regression was applied to correct for confounding factors.

Results

Our cohort included 1,209 patients, 948 (78.4%) were male and 261 (21.6%) were female. Women were older (mean age 69±11 years vs 63±11 years in males, p<0.01), had a higher rate of diabetes (41% vs 33%, p=0.015), hypertension (80% vs 65%, p<0.01) but less previous PCI (35% vs 42%, p=0.026). There were no differences in the rates of stable versus acute patients. In terms of procedural characteristics, femoral access was used in most patients of both sexes (51.2% vs 56.3%, p=0.177) but female patients had more calcified (38% vs 30%, p=0.017) and ulcerated lesions (13% vs 10%, p=0.189), and more were treated by mechanical aspiration (7% vs 4%, p=0.05). At 1 year, there was a trend towards an increased MACE amongst women (18.8% vs 15.2%, p=0.183). At 3 year follow up, there were significantly more deaths in women (14% vs 7%, p<0.01) and a higher rate of MACE (29% vs 22%, p=0.026). This effect remained following correction for confounders (MACE at 3 years: HR=1.87 95% CI 1.04-3.34, p=0.035).

Conclusion

Female sex is an independent predictor for poor outcomes amongst patients undergoing PCI for bifurcation lesions.