Sex Differences in Patients Undergoing Left Main Stem Percutaneous Coronary Intervention for Stable Angina: Data From a National Registry.

Shamkhani, Warkaa; Zathar, Zafraan; Khattak, Sophia; Nolan, James; Chieffo, Alaide; Kinnaird, Tim; Mamas, Mamas A

Abstract

Percutaneous coronary intervention (PCI) of the left main coronary artery (LMCA) for stable angina has steadily increased. Outcomes stratified by sex are inconclusive and limited. We assessed sex-based trends and differences in clinical outcomes among patients with stable angina who received LMCA PCI. We retrospectively collected data on patients with stable angina who underwent LMCA PCI (2006-2022) from the UK national PCI registry. The primary outcome of interest was inpatient mortality. Secondary outcomes were major bleeding and major cardiovascular and cerebral events. Multivariate logistic regression was used to assess adjusted odds ratio for outcome of interest. Of the 24 271 LMCA PCI performed, 5497 (22.7%) were in women. Women were older than men (median 72.7 versus 70.4) and less likely to have their PCI via radial access (50.3% versus 58.9%). More women had PCI guided by intravascular ultrasound (43.4% versus 41.2%). Women had significantly lower comorbid burden than men. Higher prevalence of chronic renal failure (6.72% versus 4.77%), smoking history (61.47% versus 45.68%), diabetes (27.36% versus 25.74%), prior myocardial infarction (45.36% versus 35.89%), and prior coronary artery bypass grafting (42.13% versus 30.34%) was observed in men than in women, respectively; value <0.005 for all. Women had higher adjusted mortality (adjusted odds ratio, 1.63 [95% CI, 1.1-2.3]) and major bleeding events (adjusted odds ratio, 2.07 [95% CI, 1.19-3.59]). Although odds of major cardiovascular and cerebral events (adjusted odds ratio, 1.27[95% CI, 0.9-1.6]) were higher in women, it was not statistically significant. Despite being less comorbid, women had a significant increase in their mortality and major bleeding events following LMCA PCI. A sex-tailored approach considering age, intravascular imaging, and vascular access may improve outcomes.

Citation

Shamkhani, W., Zathar, Z., Khattak, S., Nolan, J., Chieffo, A., Kinnaird, T., & Mamas, M. A. (2024). Sex Differences in Patients Undergoing Left Main Stem Percutaneous Coronary Intervention for Stable Angina: Data From a National Registry. Journal of the American Heart Association, 13(22), Article e036569. https://doi.org/10.1161/JAHA.124.036569

• Journal Article Type: Article
• Acceptance Date: Sep 18, 2024
• Online Publication Date: Nov 15, 2024
• Publication Date: Nov 19, 2024
• Deposit Date: Jan 27, 2025
• Journal: Journal of the American Heart Association
• Electronic ISSN: 2047-9980
• Publisher: Wiley Open Access
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Issue: 22
• Article Number: e036569
• DOI: https://doi.org/10.1161/JAHA.124.036569
• Keywords: Percutaneous Coronary Intervention, adverse effects, mortality, statistics & numerical data, Angina, Stable - surgery - mortality - therapy, stable angina, Retrospective Studies, Registries, Middle Aged, Risk Factors, Hospital Mortality - trends, Humans, Treatment Outcome, Sex Factors, Aged, United Kingdom - epidemiology, Risk Assessment, Male, sex differences, PCI, left main coronary artery, Aged, 80 and over, Female
• Public URL: https://keele-repository.worktribe.com/output/984811