Sex-related differences in patients undergoing percutaneous unprotected left main stenting.
OBJECTIVE
Percutaneous coronary intervention (PCI) is increasingly being used for unprotected left main (ULM) disease. Limited data are available on sex-related differences in this setting. We investigated gender-associated differences in patients undergoing stent-based PCI for ULM.


RESULTS
We analysed baseline, procedural and long-term data of patients with ULM undergoing stent-based PCI at participating centres. The primary end-point was the long-term rate of major cardiovascular events rate (MACE, i.e., the composite of death, myocardial infarction, or target lesion revascularisation). The study population included 1,452 cases, with 27.8% females and 72.2% males. Women were older, more frequently diabetic, hypertensive or presenting with an acute coronary syndrome, and thus with a higher EuroSCORE, but were less commonly treated with drug-eluting stents (DES), in comparison to men (all p<0.01). After a median follow-up of 18 months, women showed an unadjusted higher risk of death (p=0.040), cardiac death (p=0.033), and the death/myocardial infarction (p=0.012). However, after multivariable adjustment, gender was no longer an independent predictor of death (hazard ratio=1.119 [0.804-1.558]), cardiac death (hazard ratio=1.045 [0.697-1.567]), or death/myocardial infarction (hazard ratio=0.531 [0.192-1.465]), given the predominant role of age, diabetes and EuroSCORE as independent predictors and confounders of the gender-based comparison.


CONCLUSIONS
Women undergoing PCI for ULM present more often with an acute coronary syndrome, are treated less frequently with DES, and have more adverse events, but these gender biases are not confirmed after adjusting for confounders. Thus, stent-based PCI for ULM offers similarly favourable clinical results in women as well as in men.
Divisione di Cardiologia, Università di Torino, Turin, Italy.
Imad
I
Sheiban
Carlo
C
La Spina
Erika
E
Cavallero
Giuseppe
G
Biondi-Zoccai
Francesco
F
Colombo
Tullio
T
Palmerini
Antonio
A
Marzocchi
Corrado
C
Tamburino
Massimo
M
Margheri
Giuseppe
G
Vecchi
Giuseppe
G
Sangiorgi
Andrea
A
Santarelli
Antonio L
AL
Bartorelli
Carlo
C
Briguori
Luigi
L
Vignali
Francesco
F
di Pede
Angelo
A
Ramondo
Cecilia
C
Fantoni
Marco
M
de Carlo
Giovanni
G
Falsini
Alberto
A
Benassi
Cataldo
C
Palmieri
Vincenzo
V
Filippone
Diego
D
Sangiorgi
Stefano
S
de Servi
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome