Abstract
Objective
Although coronary artery disease (CAD) remains the leading cause of death worldwide, patient-level data on long-term outcomes in Eastern Europe are limited, particularly in Romania, where high poverty rates and low gender equality persist. This study aimed to identify sex-based differences in long-term survival after percutaneous coronary intervention (PCI) in a prospective Romanian registry of PCI procedures.
Methods
A prospective analysis was conducted on an all-comers patient population who underwent PCI at a tertiary cardiovascular center, starting from January 2016. Data on cardiovascular and all-cause mortality were available through December 2023.
Results
High all-cause and cardiovascular cause mortality rates were noted in the whole population. Women were significantly older and had more non-cardiac comorbidities. They more frequently presented with ST-elevation acute coronary syndrome (ACS-STE) and had worse clinical status at admission (higher GRACE and ACEF scores). Time to PCI was significantly longer for women, and they experienced higher in-hospital complication rates, including cardiogenic shock (3.22% vs. 1.9%, p=0.001) and mortality (5.19% vs. 2.7%, p=0.0005). Despite more severe presentation, women were less likely to receive guideline-recommended therapies. Long-term survival was lower in women with ACS-STE for both all-cause and cardiovascular mortality (p<0.0001), whereas no sex differences were observed in non-ST elevation ACS. In chronic coronary syndrome, male patients had higher long-term all-cause mortality. However, after adjusting for potential confounders, gender was not found to be an independent predictor of survival.
Conclusion
Although gender per se was not an independent determinant of survival, we identified significant sex-related differences in clinical characteristics and treatment patterns of CAD patients.