Key result
Female sex is linked to ~13% higher 1-year major bleeding risk after PCI in elderly patients.
Why the study?
Because women undergoing PCI are typically older with greater comorbidity burden, it remained uncertain whether sex-based outcome disparities persist specifically within an elderly population aged ≥65 years after adjustment for baseline characteristics.
Does female sex compared with male sex affect 1-year major bleeding and clinical outcomes in elderly patients (aged ≥65 years) with acute coronary syndrome undergoing PCI?
Cohort (n=101,094)
Yes
Does female sex compared with male sex affect 1-year major bleeding and clinical outcomes in elderly patients (aged ≥65 years) with acute coronary syndrome undergoing PCI?
In elderly patients with acute coronary syndrome undergoing PCI, 1-year survival is similar between sexes after propensity matching, but women face higher bleeding and hospitalization risks whereas men experience higher rates of repeat revascularization and new-onset atrial fibrillation.
Higher bleeding risk in elderly women post-PCI should not yet change practice; extends sex-specific outcome data but requires prospective confirmation.
Background Sex differences after percutaneous coronary intervention (PCI) are well recognized1; however, women undergoing PCI are typically older and have greater comorbidity burden2, making it uncertain whether outcome disparities persist within an elderly population. As contemporary PCI populations are increasingly aged ≥65 years, understanding sex-specific risks in this group is clinically important for treatment planning and follow-up strategies. Purpose We aimed to evaluate sex-specific clinical outcomes after PCI among elderly patients and to determine whether men and women demonstrate distinct post-procedural risk profiles after adjustment for baseline characteristics. Methods We performed a retrospective cohort study using the TriNetX global collaborative network. Patients aged ≥65 years diagnosed with acute coronary syndrome, undergoing PCI were identified and stratified by sex. Propensity score matching (1:1) was performed, adjusting for age, body mass index (BMI), cardiovascular comorbidities, and medications. Outcomes at 1 year included major bleeding (primary outcome), all-cause mortality, repeat revascularization, new onset of atrial fibrillation (AF), and all-cause hospitalization. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated. Results A total of 142,885 patients were identified before matching. After propensity score matching, 50,547 matched pairs were included in the analysis. At 1 year, women had a higher risk of major bleeding compared with men (HR 1.13, 95% CI 1.068 – 1.196, p-value < 0.0001), and higher all-cause hospitalization (HR 1.061, 95% CI 1.042 – 1.081, p-value < 0.0001). All-cause mortality was similar between groups (HR 1.014, 95% CI 0.976 – 1.054, p-value = 0.4807). Men had higher risks of repeat revascularization (HR 0.86, 95% CI 0.833 – 0.887, p-value < 0.0001) and new-onset AF (HR 0.907, 95% CI 0.859 – 0.958, p-value = 0.0004). Conclusion In elderly PCI patients, sex differences were more pronounced for safety than survival: women experienced higher bleeding risk, whereas men had higher repeat revascularization. These findings support sex-aware risk assessment when tailoring post-PCI antithrombotic and follow-up strategies.
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Melisa et al. (2026) conducted a cohort in Acute coronary syndrome undergoing PCI (n=101,094). Female sex vs. Male sex was evaluated on Major bleeding at 1 year (HR 1.13, 95% CI 1.068-1.196, p=<0.0001). Female sex was associated with higher 1-year major bleeding risk vs men after PCI in elderly patients (HR 1.13; 95% CI 1.068-1.196; P<0.0001), with similar mortality.
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