Key result
Women undergoing percutaneous coronary intervention for complex bifurcation disease have higher event rates largely driven by bleeding, with evidence suggesting better outcomes with CABG.
Why the study?
The effect of gender on PCI outcomes in complex coronary disease such as bifurcation disease is less well-known, and many bifurcation trials are underpowered for subgroup analyses in women.
This review highlights that women with complex coronary bifurcation disease may have better outcomes with CABG compared to PCI, as PCI is associated with higher bleeding-driven events.
Sex not independently linked to worse bifurcation PCI outcomes after adjustment; leaves open dedicated trials in women.
Several studies have examined the efficacy of drug-eluting stents in acute and chronic coronary syndromes and demonstrated benefit in both men and women. However, the effect of gender on percutaneous coronary intervention (PCI) outcomes in more complex disease including bifurcation disease is less well-known. In particular, a two-stent or provisional strategy, for both left Main and non-Left Main bifurcation lesions, has been variable across the different studies. In addition, there is a notable geographic preference whereby a stepwise provisional strategy with culotte as a bailout technique is preferred in Europe while in Asia there is a predilection to DK Crush for a 2-stent strategy. Many of these trials, however, are underpowered to conduct subgroup analysis for outcomes in women. To date, the evidence suggests women have better outcomes with coronary artery bypass grafting in complex disease. The higher events in women undergoing PCI are largely driven by bleeding. Studies dedicated to evaluating outcomes after complex revascularization in women are desperately needed with long-term follow-up. This review examines the current landmark trials as they pertain to outcomes in women.
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Alasnag et al. (2022) conducted a review in Complex coronary artery disease and bifurcation lesions. Bifurcation stenting strategies (PCI) vs. Coronary artery bypass grafting (CABG) or alternative stenting strategies was evaluated. Women undergoing percutaneous coronary intervention for complex bifurcation disease have higher event rates largely driven by bleeding, with evidence suggesting better outcomes with CABG.
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