Sex Differences in Outcomes of Complex Percutaneous Coronary Interventions Assisted With Mechanical Circulatory Support Devices

BackgroundSex-based disparities persist in the management of patients with coronary artery disease undergoing complex percutaneous coronary intervention (PCI).ObjectivesThe purpose of this study was to evaluate sex differences in early and late outcomes among patients undergoing mechanical circulatory support (MCS)-assisted complex PCI.MethodsWe conducted a retrospective analysis of hemodynamically stable patients who underwent complex PCI assisted with either an intra-aortic balloon pump or Impella (Abiomed) at a single center between 2017 and 2022. The primary endpoint was 1-year major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, and stroke. Secondary endpoints included individual MACE components, target vessel revascularization, bleeding, and procedural complications.ResultsAmong the 605 included patients, 24% were women (n = 145). Women had a higher comorbidity burden, presented more frequently with non-ST-segment elevation myocardial infarction, and experienced significantly more in-hospital complications, particularly bleeding. At 1 year, women had higher rates of MACE compared with men (25.5% vs 13.8%; P = 0.002), driven largely by excess mortality (20.8% vs 10.2%; P = 0.003), irrespective of MCS device type. After multivariable adjustment, the difference in MACE was no longer statistically significant (adjusted HR: 1.34; 95% CI: 0.74-3.03; P = 0.337).ConclusionsWomen undergoing complex PCI with MCS support experienced higher procedural risk and worse early outcomes, yet adjusted 1-year MACE rates were comparable to men. The marked absolute differences in bleeding and mortality highlight the need for sex-specific approaches to patient selection, procedural planning, and post-PCI management in this high-risk population.