ArticleJACC. Advances2025
Sex Differences in State-of-the-Art Management for Left Main Disease.
Article in JACC. Advances, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAlthough higher mortality has been reported among women undergoing coronary revascularization for left main coronary artery disease (LMD), it remains unclear whether contemporary approaches can address these disparities.
objectivesWe investigated sex differences in outcomes using the DEFINE-LM (deferral of coronary revascularization based on instantaneous wave-free ratio evaluation for left main coronary artery disease) registry, in which state-of-the-art management was employed.
methodsWe analyzed 314 patients from an international, multicenter registry, where all patients received state-of-the-art management, including physiology-guided revascularization decisions, intracoronary imaging-optimized drug-eluting stent deployment, or surgical procedures with internal thoracic artery grafts, alongside guideline-directed medical therapy. The cohort included 65 (20.7%) women and 249 (79.3%) men. The primary endpoint was a composite of death, nonfatal myocardial infarction (MI), and ischemia-driven target lesion revascularization of the left main stem (LM-TLR). Secondary endpoints were 1) cardiac death or spontaneous LMD-related MI and 2) LM-TLR.
resultsPatient and lesion characteristics were comparable, except for significantly higher age in women (70.1 ± 9.9 vs 67.6 ± 10.3, P = 0.02). At 30 months (Q1-Q3: 17-44), the primary endpoint occurred in 13.8% (9/65) of women and 11.2% (28/249) of men (HR: 1.15; 95% CI: 0.54-2.45; P = 0.71). Regarding secondary endpoints, no significant differences were observed in cardiac death or LMD-related MI (1.5% [1/65] vs 1.6% [4/249]; HR: 0.62; 95% CI: 0.07-5.34; P = 0.66) or LM-TLR (7.7% [5/65] vs 4.0% [10/249]; HR: 1.68; 95% CI: 0.57-4.94; P = 0.35). Cox regression analysis adjusting for age further demonstrated that patient sex was not a significant factor for the primary endpoint (P = 0.98).
conclusionsState-of-the-art LMD revascularization yielded comparable outcomes for women and men, despite women being significantly older.
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