Sex-based differences and outcomes of unselected patients undergoing coronary angiography

Tobias Schupp (Mannheim)1, L. Kuhn (Mannheim)1, P. Steinke (Mannheim)1, M. Abumayyaleh (Mannheim)1, K. J. Weidner (Mannheim)1, F. Stroop (Mannheim)1, T. Bertsch (Nürnberg)2, M. Akin (Hannover)3, I. Akin (Mannheim)1, M. Behnes (Mannheim)1

1Universitätsklinikum Mannheim I. Medizinische Klinik Mannheim, Deutschland; 2Klinikum Nürnberg Nord Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin Nürnberg, Deutschland; 3Medizinische Hochschule Hannover Kardiologie und Angiologie Hannover, Deutschland


The study investigates sex-related differences and outcomes in unselected patients undergoing invasive coronary angiography (CA).

Background: During the past decades, the spectrum of patients undergoing CA has significantly changed due to ongoing demographic changes and improved treatment strategies for patients with cardiovascular disease. The availability of data regarding sex-related characteristics and outcomes in unselected patients undergoing CA is limited.

Methods: Consecutive patients undergoing invasive CA from 2016 to 2022 were included at one institution. Firstly, the prevalence and extent of CAD, as well as procedural-related data was assessed comparing males and females. Secondly, the prognosis of males and females undergoing CA was investigated with regard to the primary endpoint in-hospital all-cause mortality at 30 days. Secondary endpoints comprised the risk of acute myocardial infarction (AMI), revascularization and hospitalization for heart failure at 36 months of follow-up. Statistical analyses included Kaplan-Meier analyses, as well as uni- and multivariable Cox proportional regression analyses.

Results: From 2016 to 2022, 7,691 patients undergoing CA were included (males: 65.1%; females: 34.9%). Males had a higher prevalence of CAD (76.2% vs. 57.4%; p = 0.001) and a higher prevalence of 3-vessel CAD compared to females (33.9% vs. 20.3%; p = 0.001), alongside with a higher need for percutaneous coronary intervention (PCI) during index CA (47.1% - 35.5%; p = 0.001). At 30 days, the risk of in-hospital all-cause mortality did not differ among males and females (6.3% vs. 6.2%; p = 0.680; HR = 1.039; 95% CI 0.862 – 1.252; p = 0.689). However, the risk of revascularization at 36 months was higher in males compared to females (9.6% vs. 5.9%; p = 0.001), which was still evident after multivariable adjustment (HR = 1.618; 95% CI 1.326 – 1.975; p = 0.001). Finally, the risk of rehospitalization for heart failure was increased in males (22.4% vs. 20.3%; p = 0.036).

Conclusion: Although males presented with a higher prevalence and extent of CAD compared to females, the risk of in-hospital 30-day all-cause mortality did not differ among both sexes. However, males were associated with a higher risk of revascularization at 30 months and heart failure, which may be in line with the progression of ischemic cardiomyopathy in males.

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