A sex paradox in clinical outcomes following complex percutaneous coronary intervention

Johny Nicolas, Bimmer E. Claessen, Davide Cao, Mauro Chiarito, Samantha Sartori, Hanbo Qiu, Ridhima Goel, Matteo Nardin, Anastasios Roumeliotis, Birgit Vogel, Ali Turfah, Rishi Chandiramani, Usman Baber, Nitin Barman, Joseph Sweeny, Prakash Krishnan, Annapoorna Kini, Samin K. Sharma, George D. Dangas, Roxana Mehran

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Although the number of complex percutaneous coronary intervention (CPCI) procedures is increasing, data regarding sex-related outcomes following CPCI are scarce. Methods: We retrospectively analyzed data of patients enrolled in a single-center registry between 2009 and 2017. Patients were divided into two groups (CPCI and non-CPCI) stratified by sex. CPCI was defined as any PCI procedure with ≥1 of the following characteristics: ≥3 target vessels/lesions, ≥3 stents implanted, bifurcation with ≥2 stents, stent length > 60 mm, or chronic total occlusion. The primary outcome was major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction (MI), and target vessel revascularization, at oneon-year follow-up. Results: Among 20,419 patients, 5004 (24.5%) underwent CPCI of whom 25.6% (n = 1281) women and 74.4% (n = 3723) men. Women presented with more comorbidities yet less complex coronary anatomy than men (syntax score: 19.5 ± 10.3 vs. 20.6 ± 10.7, p = 0.009). Moreover, women were more likely to fulfill a single rather than multiple CPCI criteria. At one year, a higher rate of MACE occurred in women (14.0% vs. 11.6%, p = 0.02). After multivariable adjustment for confounders, the risk of MACE at one year was similar among both sexes (HR:1.04, 95% CI [0.85–1.26], p = 0.71), without significant interaction between the complexity of the procedure and sex (p-interaction = 0.96). Nonetheless, the risk of MI was significantly higher in women than men undergoing CPCI (HR:1.63, 95% CI [1.12–2.38], p = 0.01). Conclusions: Despite presenting with less challenging lesions than men, women had a higher rate of MI at one year following CPCI, even after adjusting for potential confounders.

Original languageEnglish
Pages (from-to)67-73
Number of pages7
JournalInternational Journal of Cardiology
StatePublished - 15 Apr 2021


  • Complex PCI
  • Coronary artery disease
  • Female
  • Sex


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