title: Sex-related differences in fractional flow reserve-guided treatment.
abstract: BACKGROUND
  Sex-specific differences affect the evaluation, treatment, and prognosis of coronary artery disease. We tested the hypothesis that long-term outcomes of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) are different between women and men.
  
  
  RESULTS
  Consecutive 1090 patients, referred for PCI and undergoing FFR measurements at the Mayo Clinic between October 2002 and December 2009, were included in this registry study. Clinical events were compared between the sexes during a median follow-up of 50.9 months. Of all patients, women had higher FFR adjusted by visual coronary stenosis than men (P=0.03). The Kaplan-Meier percent of major adverse cardiac events at 5 years was 35% in women and 38% in men (P=0.54). Interestingly, in patients undergoing PCI with an FFR <0.75, the incidence of death or myocardial infarction was significantly higher in women than in men (hazard ratio, 2.16; 95% confidence interval, 1.04-4.51; P=0.04). Moreover, compared with patients with FFR >0.80, deferral of PCI for those with FFR between 0.75 and 0.80 was associated with an increased rate of major adverse cardiac events, particularly death or myocardial infarction in women (hazard ratio, 3.25; 95% confidence interval, 1.56-6.74; P=0.002) and revascularization in men (hazard ratio, 2.66; 95% confidence interval, 1.66-4.54; P<0.001).
  
  
  CONCLUSIONS
  Long-term outcome differs between women and men undergoing FFR-guided PCI. Our data suggest that the sex-based treatment strategy is necessary to further optimize prognosis of patients with coronary artery disease.
authors.affiliation: From the Division of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, China (J.L., Q.H.); Division of Cardiovascular Diseases (C.S.R., Y.M., A.C., J.H., M.R.B., D.R.H., J.F.B., A.L.), Division of General Internal Medicine (M.Y.E.), Biomedical Statistics (R.J.L.), and Division of Nephrology and Hypertension (L.O.L.), Mayo Clinic, Rochester, MN; Cardiovascular Center, Cardiology, University Hospital Zurich, Zurich, Switzerland (A.J.F.); and Department of Preventive Medicine, College of Medicine, Konyang University, Daejeon, South Korea (M.-S.L.).
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Matsuo
authors.forename: Muhamad Y
authors.initials: MY
authors.lastname: Elrashidi
authors.forename: Andreas J
authors.initials: AJ
authors.lastname: Flammer
authors.forename: Moo-Sik
authors.initials: MS
authors.lastname: Lee
authors.forename: Andrew
authors.initials: A
authors.lastname: Cassar
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: Joerg
authors.initials: J
authors.lastname: Herrmann
authors.forename: Malcolm R
authors.initials: MR
authors.lastname: Bell
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: John F
authors.initials: JF
authors.lastname: Bresnahan
authors.forename: Qi
authors.initials: Q
authors.lastname: Hua
authors.forename: Lilach O
authors.initials: LO
authors.lastname: Lerman
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D000368:Aged; D023921:Coronary Stenosis / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: fractional flow reserve, myocardial; percutaneous coronary intervention; sex