Gender-Based Long-Term Outcomes After Revascularization for Three-Vessel Coronary Disease: A Propensity Score-Matched Analysis of a Large Cohort

Abstract

Yuguo Liu,1,2,* Yifan Zhu,1,3,* Junjie Wang,1 Da Yin,1 Haichen Lv,1 Shenglin Qu,1 Xuchen Zhou,1 Hao Zhu,1 Lei Guo,1 Yuming Li4 1Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, People’s Republic of China; 2Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin Medical University Clinical Cardiovascular Institute, Tianjin, People’s Republic of China; 3Jinzhou Medical University Dalian Friendship Hospital Postgraduate Training Base, Dalian City, People’s Republic of China; 4Department of Cardiology, Tianjin Economic-Technological Development Area (TEDA) International Cardiovascular Hospital, Tianjin, People’s Republic of China*These authors contributed equally to this workCorrespondence: Lei Guo, Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian City, 116011, People’s Republic of China, Tel [phone], Email [email protected] Yuming Li, Department of Cardiology, Tianjin Economic-Technological Development Area (TEDA) International Cardiovascular Hospital, Tianjin, People’s Republic of China, Tel [phone], Email [email protected]: To investigate the impact of gender on long-term outcomes after revascularization in patients with three-vessel disease (TVD), a severe and challenging subtype of coronary artery disease.Methods: This was a single center retrospective cohort study. 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 1:2 propensity score matching (PSM) to balance the baseline characteristics, and a total of 1506 (504 matched pairs) patients were created after undertaking PSM. The primary outcome was the frequency of major adverse cardiac and cerebrovascular events (MACCE) including all-cause death, myocardial infarction, repeat revascularization, stroke, and readmission for angina pectoris or heart failure. 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 percutaneous coronary intervention (compared with coronary artery bypass graft surgery), hypertension, diabetes mellitus, atrial fibrillation, left main trunk involvement and left ventricular ejection fraction ≤ 40% were independently associated with a higher MACCE rate in these patients.Conclusion: For patients with TVD after coronary revascularization, there were no gender-based differences in the long-term outcomes and female gender was not an independent predictor of MACCE.Keywords: three-vessel disease, coronary revascularization, gender, outcomes, coronary artery disease

Keywords

• three-vessel disease
• coronary revascularization
• gender
• outcomes
• coronary artery disease