Coronary artery disease (CAD) has historically been responsible for more deaths in women than in men and previous studies have suggested sex differences in revascularization approaches and outcomes. We sought to compare sex-specific adverse events in patients who underwent percutaneous or surgical revascularization for multivessel CAD.
All patients at a single institution undergoing PCI or CABG for multivessel CAD between 2011 and 2018 were included. Propensity score matching was utilized to compare patients with similar baseline characteristics. Outcomes included death, major adverse cardiac and cerebrovascular events (MACCE), repeat revascularization, and readmissions.
Of the 6163 patients, 1679 (27.2%) were female. Males were more likely to have 3-vessel disease (71.9% vs 68.6%, p=0.002) and to undergo complete revascularization (69.9% vs 66.4%, p=0.008). Female sex was associated with an increased hazard for death (HR 1.16, p=0.03) and MACCE (HR 1.16, p=0.02) but not repeat revascularization (HR 1.23, p=0.16). In the matched cohorts, female sex was associated with lower survival at 1 year (90.63% vs 93.12%, p=0.01) but not 5 years (76.64% vs 77.33%, p=0.20). Similarly, freedom from MACCE was lower in females at 1 year (87.79% vs 90.19%, p=0.03) but was comparable at 5 years (73.22% vs 74.3%, p=0.10).
In a matched analysis pooling percutaneous and surgical revascularization, female sex was associated with worse outcomes at 1 year though there were no sex differences at 5 years of follow-up. Increasing CABG utilization and the completeness of revascularization in females may be targets for improving 1-year survival and freedom from MACCE.

Copyright © 2020. Published by Elsevier Inc.