A personalized approach to percutaneous coronary interventions in the left main coronary artery—is the female gender associated with worse outcomes?

Abstract

There is still controversy whether the female gender is associated with worse outcomes after the percutaneous coronary intervention within the left main (LM PCI). This study aimed to examine gender-based differences in real-life LM PCI patients and present a gender-personalized LM PCI approach. Consecutively, 613 patients underwent LM PCI in our department from January 2015 to June 2019. Five hundred and thirty-three patients, with at least a one-year follow-up, were included in the study. There were 130 (24.4%) women and 403 (75.6%) men. Compared with men, women were older (70.0 ± 9.4 vs. 67.7 ± 9.2; p = 0.006) and had higher diabetes, hypertension, and chronic kidney disease rates. Left ventricle ejection fraction was higher in women (53.5 ± 9.4 vs. 49.5 ± 11.2; p = 0.001). Euroscore II and SYNTAX scores did not differ between the genders. However, we observed a trend towards more frequent use of complex PCI techniques in women (26.2% vs. 19.4%; p = 0.098). The overall periprocedural complication rates (10.0% vs. 7.7%; p = 0.406) and the periprocedural myocardial infarction rates did not differ. Contrast-induced nephropathy was more frequent in women (6.9% vs. 3.0%; p = 0.044). Long-term all-cause mortality did not differ (20% vs. 22.5%; p = 0.069). Both genders presented similar rates of periprocedural complications, and no significant differences in long-term all-cause mortality were revealed. Our results suggest that the female gender in LM PCI is not a predictor of adverse outcomes. Further studies are required to determine the optimal revascularization strategy in women.