Impact of gender on long-term mortality in patients with unprotected left main disease: The Milan and New-Tokyo (MITO) Registry.

Abstract

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. 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. 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. 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.