Kensuke Takagi1, Alaide Chieffo2, Joanne Shannon3, Toru Naganuma1, Satoko Tahara1, Yusuke Fujino1, Azeem Latib3, Matteo Montorfano2, Mauro Carlino2, Hiroyoshi Kawamoto1, Sunao Nakamura1, Antonio Colombo4. 1. Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan. 2. Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. 3. Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. 4. Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. Electronic address: info@emocolumbus.it.
Abstract
BACKGROUND: Although percutaneous intervention (PCI) for ULM is common, the impact of gender remains unclear. This study aimed to clarify the impact of gender in patients treated with drug-eluting stents (DES) for unprotected left main (ULM) disease. METHODS: Between April 2002 and August 2011, 1026 consecutive patients (212 women and 814 men) undergoing PCI using first or second generation DES for ULM stenosis were analyzed. Study endpoints included major adverse cardiac events (MACE) defined as composite of all-cause death, myocardial infarction (MI), and target lesion revascularization (TLR). Individual components of MACE and cardiac death were also evaluated. RESULTS: Women had greater comorbidity and more complex lesions, resulting in a higher incidence of cardiac death, TLR and MI {[HR, 1.94 (95% CI, 1.22-3.09, p=0.005)], [HR, 1.31 (95% CI 0.96-1.81), p=0.09] and [HR, 2.04 (95% CI, 0.98-4.25), p=0.06], respectively}. Propensity score matching identified 131 matched pairs. There were no differences in MACE [HR, 1.04 (95% CI, 0.68-1.61, p=0.85)], all-cause death [HR, 0.96 (95% CI, 0.52-1.77), p=0.89] or MI [HR, 0.84 (95% CI, 0.21-3.50, p=0.84)]. However, cardiac death [HR, 2.70 (95% CI, 0.98-7.49, p=0.056] and TLR [HR, 1.62 (95% CI, 0.93-2.84), p=0.09] showed a trend to being higher in women compared to men. CONCLUSIONS: In patients with ULM disease, women had greater comorbidity and more complex lesions, resulting in an increased risk of clinical events. However after propensity matching, there was no difference in the occurrence of MACE but cardiac death showed a trend to being higher in women compared to men.
BACKGROUND: Although percutaneous intervention (PCI) for ULM is common, the impact of gender remains unclear. This study aimed to clarify the impact of gender in patients treated with drug-eluting stents (DES) for unprotected left main (ULM) disease. METHODS: Between April 2002 and August 2011, 1026 consecutive patients (212 women and 814 men) undergoing PCI using first or second generation DES for ULM stenosis were analyzed. Study endpoints included major adverse cardiac events (MACE) defined as composite of all-cause death, myocardial infarction (MI), and target lesion revascularization (TLR). Individual components of MACE and cardiac death were also evaluated. RESULTS:Women had greater comorbidity and more complex lesions, resulting in a higher incidence of cardiac death, TLR and MI {[HR, 1.94 (95% CI, 1.22-3.09, p=0.005)], [HR, 1.31 (95% CI 0.96-1.81), p=0.09] and [HR, 2.04 (95% CI, 0.98-4.25), p=0.06], respectively}. Propensity score matching identified 131 matched pairs. There were no differences in MACE [HR, 1.04 (95% CI, 0.68-1.61, p=0.85)], all-cause death [HR, 0.96 (95% CI, 0.52-1.77), p=0.89] or MI [HR, 0.84 (95% CI, 0.21-3.50, p=0.84)]. However, cardiac death [HR, 2.70 (95% CI, 0.98-7.49, p=0.056] and TLR [HR, 1.62 (95% CI, 0.93-2.84), p=0.09] showed a trend to being higher in women compared to men. CONCLUSIONS: In patients with ULM disease, women had greater comorbidity and more complex lesions, resulting in an increased risk of clinical events. However after propensity matching, there was no difference in the occurrence of MACE but cardiac death showed a trend to being higher in women compared to men.