Gender-related differences in patients with left-main disease treated by percutaneous coronary angioplasty

Introduction: Left-main coronary artery (LMCA) lesions have been traditionally treated by cardiac surgery. More recently, percutaneous coronary interventions (PCI) have emerged as a feasible alternative to surgery in this subset of patients. Gender differences determine a number of peculiarities in the manifestation of coronary artery disease.
Objective: We aimed to characterize the presentation status, angiographic data and in-hospital complications in women compared to men undergoing LMCA PCI in our center.
Methods: The study included 121 consecutive patients treated by PCI for LMCA disease in our center between January 2010 and December 2016. Clinical and angio-graphic data together with the periprocedural and in-hospital complications were assessed for each patient and compared between men and women.
Results: Thirty-five (29%) out of the total of 121 pati-ents included in the study were females. The prevalence of diabetes (49% vs. 29%, p=0.04) and of three-vessel disease (65.7% vs. 34.8%, p=0.02) were significantly higher in women than in men. Women had poorer status at admission compared to men, presenting a higher incidence of out-hospital cardiac arrest (14.2% vs. 3.4%, p=0.03), cardiogenic shock (22.8% vs. 4.6%, p<0.01) and ST segment elevation myocardial infarcti-on (STEMI) (31.4% vs. 11.6%, p<0.01). No significant difference was found between the two genders for the SYNTAX I score (p=0.52), but the SYNTAX II PCI (median 44.5 [IQR=34.4-56.5] vs. 33.6 [IQR=25.5-42.0], p<0.001) and the EuroSCORE II (median 2.81 [IQR=1.8-26.5] vs. 1.79 [IQR=1.0-3.8], p=0.001) sco-res were higher in women. Angiographic complicati-ons were similar among the two sexes, but in-hospital death rates were higher in women (22.8% vs. 3.48%, p<0.001), as well as postprocedural renal impairment (11.4% vs. 1.1%, p=0.01) and overall in-hospital complications (48.5% vs. 12.7%, p<0.001).
Conclusions: Although LMCA PCI is less common in women, females appear to have an overall poorer status at presentation, higher incidence of STEMI, and more severe coronary artery disease than males. Females also have worse outcomes, with significantly higher rates of in-hospital mortality and overall complications. These features may explain the greater earlier mortality in women than in men with coronary artery disease treated by PCI reported in previous studies.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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