title: Sex Differences in Fractional Flow Reserve-Guided Revascularization: A Nationwide Analysis.
abstract: Women with coronary artery disease are less likely to be revascularized than men based on angiography alone. Recent studies have shown that female patients have higher fractional flow reserve (FFR) values for a given severity of coronary stenosis. However, gender differences in coronary revascularization rates following FFR assessment are unknown.
  
  
  
  The nationwide inpatient sample database was used to identify all patients who underwent FFR in the United States between January 2009 and December 2010. We used propensity score matching to compare revascularization rates and in-hospital outcomes among men and women undergoing FFR measurements.
  
  
  
  Among 3712 patients who underwent FFR during the study period, 1235 matched pairs of men and women were identified. The overall revascularization rates were lower in women than men (40.1% vs. 52.8%, p < 0.01). Women were less likely to undergo either percutaneous (35.2% vs. 45.6%, p < 0.01) or surgical revascularization following FFR than men (5.2% vs. 7.4%, p = 0.03). Women had a nonsignificant trend toward higher in-hospital mortality (0.8% vs. 0.5%, p = 0.32) and significantly higher rates of access site hematoma formation (2.7% vs. 0.8%, p < 0.01) compared to men.
  
  
  
  In conclusion, this large nationwide study reveals that coronary revascularization rates are significantly lower in women than in men even after functional assessment with FFR.
authors.affiliation: 1 Division of Cardiovascular Diseases, Department of Medicine, Temple University Hospital , Philadelphia, Pennsylvania.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Lakhter
authors.affiliation: 2 Division of Cardiology, WVU Heart & Vascular Institute, West Virginia University , Morgantown, West Virginia.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Alkhouli
authors.affiliation: 3 Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic , Rochester, Minnesota.
authors.forename: Chad J
authors.initials: CJ
authors.lastname: Zack
authors.affiliation: 4 Department of Clinical Sciences, Temple University School of Medicine , Philadelphia, Pennsylvania.
authors.forename: Huaqing
authors.initials: H
authors.lastname: Zhao
authors.affiliation: 1 Division of Cardiovascular Diseases, Department of Medicine, Temple University Hospital , Philadelphia, Pennsylvania.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Cohen
authors.affiliation: 1 Division of Cardiovascular Diseases, Department of Medicine, Temple University Hospital , Philadelphia, Pennsylvania.
authors.forename: Brian P
authors.initials: BP
authors.lastname: O'Neill
authors.affiliation: 1 Division of Cardiovascular Diseases, Department of Medicine, Temple University Hospital , Philadelphia, Pennsylvania.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Murchu
authors.affiliation: 1 Division of Cardiovascular Diseases, Department of Medicine, Temple University Hospital , Philadelphia, Pennsylvania.
authors.forename: Alfred A
authors.initials: AA
authors.lastname: Bove
authors.affiliation: 1 Division of Cardiovascular Diseases, Department of Medicine, Temple University Hospital , Philadelphia, Pennsylvania.
authors.forename: Riyaz
authors.initials: R
authors.lastname: Bashir
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States
keywords: CABG; fractional flow reserve; gender; percutaneous revascularization