The Impact of Sex on Outcomes After Revascularization for Multivessel Coronary Disease

Background. Coronary artery disease has historically been responsible for more deaths among women than 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 coronary artery disease. Methods. All patients at a single institution undergoing percutaneous coronary intervention or coronary artery bypass graft surgery for multivessel coronary artery disease 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. Results. Of the 6163 patients, 1679 (27.2%) were female. Male patients were more likely to have three-vessel disease (71.9% vs 68.6%, P = .002) and to undergo complete revascularization (69.9% vs 66.4%, P = .008). Female sex was associated with an increased hazard for death (hazard ratio 1.16, P = .03) and MACCE (hazard ratio 1.16, P = .02) but not repeat revascularization (hazard ratio 1.23, P = .16). In the matched cohorts, female sex was associated with lower survival at 1 year (90.63% vs 93.12%, P = .01) but not at 5 years (76.64% vs 77.33%, P = .20). Similarly, freedom from MACCE was lower for female patients at 1 year (87.79% vs 90.19%, P = .03) but was comparable at 5 years (73.22% vs 74.3%, P = .10). Conclusions. In a matched analysis pooling percutaneous and surgical revascularization, female sex was associated with worse outcomes at 1 year although there were no sex differences at 5 years of follow-up. Increasing coronary artery bypass graft surgery utilization and the completeness of revascularization in female patients may be targets for improving 1-year survival and freedom from MACCE. (C) 2020 by The Society of Thoracic Surgeons