Sex differences of clinical outcomes in patients undergoing percutaneous coronary intervention: a nationwide cohort study

BACKGROUND: Sex differences in outcomes after percutaneous coronary intervention (PCI) remain debated, and evidence from large Asian populations is limited. METHODS: We analyzed 136 109 patients (101 301 men; 34 808 women) without prior major cardiovascular events who underwent PCI between 2004 and 2020, using data from the Korean National Health Insurance Service. Baseline characteristics, in-hospital events, and long-term clinical outcomes were compared. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, nonfatal myocardial infarction, repeat PCI, coronary artery bypass surgery, and ischemic stroke. RESULTS: Women were older and had higher rates of hypertension and diabetes, whereas men had higher smoking and alcohol consumption rates. In-hospital adverse events, including death, ischemic stroke, and bleeding were more frequent in women (P < 0.001). However, during a mean follow-up of 3.1 years, women had a lower incidence of MACE compared to men (58.0 vs. 65.3%; P < 0.001). Multivariable Cox regression confirmed that female sex was independently associated with a lower long-term risk of MACE (adjusted hazard ratio: 0.69-0.82, P < 0.001). CONCLUSION: Despite worse in-hospital outcomes, women had a more favorable long-term prognosis after PCI compared to men. These findings emphasize the importance of sex-specific approaches in risk assessment and long-term management after PCI.