Gender matters more for safety than survival after PCI in elderly patients
S Melisa, A A Lukito, M H Hsu, J C HsuAbstract
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.For image description, please refer to the figure legend and surrounding text.Figure 2.Major BleedingFor image description, please refer to the figure legend and surrounding text.