Korean Circ J.  2025 Jan;55(1):5-16. 10.4070/kcj.2024.0172.

Sex Differences in Procedural Characteristics and Clinical Outcomes Among Patients Undergoing Bifurcation PCI

• Ahn HJ
• Bruno F
• Kang J
• Hwang D
• Yang HM
• Han JK
• Luca LD
• Filippo Od
• Mattesini A
• Park KW
• Truffa A
• Wanha W
• Song YB
• Gili S
• Chun WJ
• Helft G
• Hur SH
• Cortese B
• Han SH
• Escaned J
• Chieffo A
• Choi KH
• Gallone G
• Doh JH
• Ferrari GD
• Hong SJ
• Quadri G
• Nam CW
• Gwon HC
• Kim HS
• D’Ascenzo F
• Koo BK

• KMID: 2564717
• DOI: http://doi.org/10.4070/kcj.2024.0172

Abstract

Background and Objectives
The risk profiles, procedural characteristics, and clinical outcomes for women undergoing bifurcation percutaneous coronary intervention (PCI) are not well defined compared to those in men.
Methods
COronary BIfurcation Stenting III (COBIS III) is a multicenter, real-world registry of 2,648 patients with bifurcation lesions treated with second-generation drug-eluting stents. We compared the angiographic and procedural characteristics and clinical outcomes based on sex. The primary outcome was 5-year target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization.
Results
Women (n=635, 24%) were older, had hypertension and diabetes more often, and had smaller main vessel and side branch reference diameters than men. The pre- and post-PCI angiographic percentage diameter stenoses of the main vessel and side branch were comparable between women and men. There were no differences in procedural characteristics between the sexes. Women and men had a similar risk of TLF (6.3% vs. 7.1%, p=0.63) as well as its individual components and sex was not an independent predictor of TLF. This finding was consistent in the left main and 2 stenting subgroups.
Conclusions
In patients undergoing bifurcation PCI, sex was not an independent predictor of adverse outcome.

Keyword

Sex difference; Percutaneous coronary intervention; Coronary artery disease; Coronary vessels; Drug-eluting stents

Figure

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  Figure 1 Sex difference in reference diameter and percent diameter stenosis.Reference diameter was smaller in women than men for both the MV and SB. However, percent diameter stenoses of the MV and SB were comparable in women and men before and after bifurcation PCI. (A) Maximum, minimum and median is expressed in horizontal lines and interquartile range in colors. (B) Median value is expressed in circle (MV) or square (SB) and interquartile range in error bars.MV = main vessel; PCI = percutaneous coronary intervention; SB = side branch.

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  Figure 2 Sex differences in lesion and procedural characteristics in bifurcation PCI.There were no differences in lesion and procedural characteristics between women and men.IVUS = intravascular ultrasound; PCI = percutaneous coronary intervention.

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  Figure 3 Five year time-to-event curves for the primary outcome and its individual components by sex.Women showed comparable outcomes to men for the primary outcome (TLF) and its individual components.MI = myocardial infarction; TLF = target lesion failure; TLR = target lesion revascularization.

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  Figure 4 Primary outcome according to sex in left main, 2 stenting groups.Patients undergoing left main PCI or 2 stenting techniques also showed similar outcomes between sexes.PCI = percutaneous coronary intervention.

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