Sex‐based treatment and outcomes for coronary bifurcation stenting: A report from the e‐ULTIMASTER registry

Doolub, Gemina; Iannaccone, Mario; Rab, Tanveer; Routledge, Helen; Aminian, Adel; Chevalier, Bernard; Hildick‐Smith, David; Jacobs, Lotte; Kobo, Ofer; Roguin, Ariel; Chieffo, Alaide; Mamas, Mamas A.

Abstract

Background
Percutaneous coronary intervention (PCI) for bifurcation lesions can be technically challenging and is associated with higher risk. There is little data on sex-based differences in strategy and outcomes in bifurcation PCI.

Aims
We sought to assess whether differences exist between women and men in the treatment and outcomes of bifurcation PCI.

Methods
We collected data on 4006 patients undergoing bifurcation PCI, from the e-ULTIMASTER study, a prospective, multicentre study enrolling patients from 2014 to 2018. We divided the bifurcation cohort according to sex, with 1-year follow-up of outcomes (target lesion failure [TLF], target vessel failure [TVF], and patient-oriented composite endpoint [POCE]).

Findings
Women were older (69.2 ± 10.9 years vs. 64.4 ± 11.0 years), with a greater burden of cardiovascular comorbidities. For true and non-true bifurcation lesions, women and men were equally likely to undergo a single stent approach (true: 63.2% vs. 63.6%, p = 0.79, non-true: 95.4% vs. 94.3%, p = 0.32), with similar rates of final kissing balloon (FKB) (37.2% vs. 35.5%, p = 0.36) and proximal optimization (POT) (34.4% vs. 34.2%, p = 0.93) in cases where two stents were used. Lastly, after propensity score matching, there was no difference between women and men in the incidence of the composite endpoints of TLF (5.5% vs. 5.2%, RR 1.05 [95% CI 0.77−1.44], p = 0.75), TVF (6.2% vs. 6.3%, RR 0.99 [95% CI 0.74−1.32], p = 0.96), and POCE (9.9% vs. 9.5%, RR 1.05 [95% CI 0.83−1.31], p = 0.70).

Conclusion
In this contemporary, real-world study of bifurcation PCI, we report no difference in stent strategy between women and men, with similar outcomes at 1-year.

Citation

Doolub, G., Iannaccone, M., Rab, T., Routledge, H., Aminian, A., Chevalier, B., Hildick‐Smith, D., Jacobs, L., Kobo, O., Roguin, A., Chieffo, A., & Mamas, M. A. (in press). Sex‐based treatment and outcomes for coronary bifurcation stenting: A report from the e‐ULTIMASTER registry. Catheterization and Cardiovascular Interventions, 102(3), 430-439. https://doi.org/10.1002/ccd.30770

• Journal Article Type: Article
• Acceptance Date: Jul 9, 2023
• Online Publication Date: Jul 18, 2023
• Deposit Date: Jul 25, 2023
• Journal: Catheterization and Cardiovascular Interventions
• Print ISSN: 1522-1946
• Electronic ISSN: 1522-726X
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 102
• Issue: 3
• Pages: 430-439
• DOI: https://doi.org/10.1002/ccd.30770
• Keywords: sex, clinical research, drug‐eluting stent, bifurcation
• Public URL: https://keele-repository.worktribe.com/output/519354