Sex differences in the impact of marital status on coronary artery disease outcomes in Korea

BACKGROUND: Coronary artery disease (CAD) outcomes are influenced by social determinants, including marital status. However, research on the sex-specific effects of marital status on CAD outcomes is limited. This study aimed to evaluate the relationship between marital status and clinical outcomes of patients with CAD stratified according to sex in Korea. METHODS: A total of 3476 patients with CAD who underwent percutaneous coronary intervention (PCI) were enrolled in this retrospective observational study. Patients were categorized into married and nonmarried groups based on demographic data at the time of admission. The primary endpoint was all-cause mortality. RESULTS: Among the study population, 20.7% of women and 11.5% of men who underwent PCI for CAD were nonmarried. For 87.1% of nonmarried women, the cause of being nonmarried was the death of a spouse, whereas for 48.3% of unmarried men, the most common cause was being unmarried. During a median follow-up of 53.3 months, in analysis using the Cox proportional hazard regression model, nonmarried status was associated with higher all-cause [adjusted hazard ratio (HR): 2.24, 95% confidence interval (CI): 1.22-4.09, P = 0.009] and cardiovascular (adjusted HR: 2.63, 95% CI: 19.91-5.80, P = 0.017) deaths in men but not in women. CONCLUSION: Marital status independently predicted the adverse outcomes in men with CAD but not in women, highlighting the importance of sex-specific approaches to the assessment of social determinants in cardiovascular care. Future studies should explore broader social and economic factors to inform targeted interventions.