Sex differences in long-term outcomes after revascularization for three-vessel coronary disease

Background: To investigate the impact of gender on long-term outcomes of after revascularization in patients with three-vessel disease (TVD), a severe type of coronary artery disease (CAD).Methods: A total of 3776 patients with TVD who underwent revascularization between 2013 and 2018 were analyzed and were divided into the female group (n = 1039, 27.5%) and the male group (n = 2737, 72.5%). We performed a propensity score matching (PSM) to balance the baseline characteristics. The primary outcome was the frequency of major adverse and cerebrovascular events (MACCE). The secondary outcome was the incidence of all-cause death. Results: Through 2.4-year follow-up, no significant differences in MACCE (25.8% vs. 27.5%, p = 0.279) and all-cause death (2.1% vs. 2.2%, p = 0.888) were observed between the two cohorts. Similar results as with the early detection were obtained in propensity-matched patients. Multivariable analysis revealed that female gender (hazard ratio 0.99, 95% confidence interval 0.88-1.17, p = 0.820) was not an independent predictor of MACCE but hypertension, diabetes mellitus, atrial fibrillation, left main trunk involvement and left ventricular ejection fraction (LVEF) ≤ 40% were independently associated with a higher MACCE rate in these patients. Conclusions: For patients with TVD after coronary revascularization, there were no sex-related differences in the long-term outcomes and female gender was not an independent predictor of MACCE.