Association of Sex with Ten-Year Outcomes after Percutaneous Coronary Intervention of In-stent Restenosis

Constantin Kuna (München)1, C. Bradaric (München)2, M. Schröter (München)1, A. Presch (München)1, F. Voll (München)1, S. Kufner (München)1, T. Ibrahim (München)2, H. Schunkert (München)1, K.-L. Laugwitz (München)2, S. Cassese (München)1, A. Kastrati (München)1, J. Wiebe (München)1

1Deutsches Herzzentrum München Klinik für Herz- und Kreislauferkrankungen München, Deutschland; 2Klinikum rechts der Isar der Technischen Universität München Klinik und Poliklinik für Innere Medizin I München, Deutschland


Background: In-stent restenosis (ISR) represents the most common reason for treatment failure after percutaneous coronary intervention (PCI) of coronary artery stenosis with every fifth patient developing ISR during long-term follow up. However, only few data is available for sex-related long-term outcomes of patients being treated for coronary ISR. Thus, the aim of this observational, retrospective study was to close this lack of evidence.

Methods: Between January 2007 and February 2021 a total of 3,511 patients were treated for 5,497 ISR lesions at two large-volume centers in Munich, Germany. 78.3% were male (2,748 patients). Endpoints of interest were all-cause mortality, target-lesion revascularization (TLR) and target-vessel myocardial infarction (TVMI). Furthermore, recurrent ISR were assessed. Outcomes are presented as Kaplan-Meier event rates.

Results: Mean age of the male was 68.4 ± 10.4 years, that of the female patients 72.1 ± 10.4 years (p<0.001). 35.4% of the total patient cohort were diabetics and 29.3% presented with acute coronary syndrome. After ten years, the rates for all-cause mortality were 46.0% in male and 54.7% in female patients (p=0.022). Target vessel revascularization (TVR) occurred in 28.5% in male and in 20.8% in female (p<0.001), non-target vessel revascularization (NTVR) in 41.3% in male and in 31.1% in female patients (p<0.001). No statistically relevant sex-related differences were found between the rates of TLR, TVMI, non-target vessel myocardial infarction (NTVMI) and stent thrombosis (ST). ISR was treated with drug-eluting stents (DES) in 53.4%. 

Conclusion: In the long-term all-cause mortality after PCI of DES-ISR is higher in female than in male patients with female patients being older at the time of ISR treatment. The rates of TVR and NTVR are higher in male patients.

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