Sex‐Related Differences in the Prevalence and Clinical Outcomes of Moderate‐to‐Severe Coronary Artery Calcification in Patients Undergoing Percutaneous Coronary Intervention

BACKGROUND: It was still unclear whether sex-related differences in the prevalence and clinical outcomes of patients with moderate-to-severe coronary artery calcification (MSCAC) who underwent percutaneous coronary intervention (PCI). AIMS: We aimed to evaluate sex-related differences in the prevalence and clinical outcomes in patients who underwent MSCAC-PCI. METHODS: We analyzed 10,681 consecutive patients with or without MSCAC from the prospective Fuwai PCI Registry. The primary outcome was the major adverse cardiovascular and cerebrovascular event (MACCE, a composite of cardiovascular death, myocardial infarction, and stroke). RESULTS: Among 10,681 patients who underwent PCI, 18.24% of patients had MSCAC. The prevalence of MSCAC was 19.81% in women and 17.99% in men. Before age 62, MSCAC prevalence predominated in men, whereas after age 62, women exhibited higher prevalence. For individuals aged ≥ 62 years, females again showed a higher prevalence of MSCAC compared to males (adjusted OR, 1.24; 95% CI, 1.01-1.52), and there was no significant difference between sexes in patients aged < 62 years. Among patients with MSCAC, relative to men, women have a higher risk of MACCE (adjusted HR, 2.89; 95% CI, 1.56-5.34), primarily coming from the increased risk of cardiovascular death and stroke. CONCLUSION: In this study, women with MSCAC faced higher long-term cardiovascular risks compared with men. An age-dependent divergence in MSCAC prevalence was observed, with higher prevalence in women after age 62.