Sex disparities in coronary re-vascularisation and mortality

INTRODUCTION: Ischemic heart disease (IHD) is, despite improvement last decades, still a leading cause of death globally. Clinical IHD guidelines do not distinguish between sex, although females experience higher mortality. This study aimed to investigate sex and procedure disparities after revascularization in patients with chronic coronary syndrome (CCS) and further correlate findings to the background population mortality. METHODS: The study included 40,565 first entry revascularizations by CABG or PCI from 2000–2020 obtained from Western Denmark Heart Registry. Kaplan–Meier survival curves evaluated mortality and re-intervention free survival, and logistic regression analysed the impact of identified risk factors. RESULTS: Females constituted 45.5% of first-entry CCS patients undergoing diagnostic coronary angiography but accounted for only 25% of those who subsequently underwent revascularization, indicating a substantially lower revascularization rate compared with males. All-cause 10-year mortality were higher in females after both CABG 1.15 (1.06–1.25) and PCI 1.17 (1.11–1.23), Males had marginally higher 10-year mortality after CABG compared to PCI (1.04 (1.00–1.10)), while no difference in females (1.03 (0.95–1.13)). Further, males had better survival than the background population, three years after both CABG and PCI, while females after PCI surpassed the population survival after six years but never reached the background population after CABG. Regarding the number of treated vessels/grafts single-PCI had lowest mortality followed by CABG, while 3-vessel PCI had the highest mortality. CONCLUSION: Despite being referred for coronary angiography according to their IHD prevalence, females receive revascularization treatment less frequently and experienced significantly higher mortality after revascularization than males. The difference becomes especially evident when compared to the background population mortality where males demonstrated better survival than population three years after both CABG and PCI, while PCI-treated females surpassed exceeded the population survival after six years but never captured population after CABG.