Sex disparities in coronary re-vascularisation and mortality

Introduction Ischemic heart disease (IHD) is, despite improvement last decades, still a leading cause of death globally. Clinical IHD guidelines do not distinguish between genders, although females experience higher mortality. This study aimed to investigate gender and procedure disparities after revascularization in patients with chronic coronary syndrome (CCS) and further correlate findings to the background population mortality. Methods The study included 40,565 first entry revascularizations by CABG or PCI from 2000–2020 obtained from Western Denmark Heart Registry. Kaplan-Meier survival curves evaluated mortality and re-intervention free survival, and logistic regression analysed the impact of identified risk factors. Results Females experienced revascularization substantially less often than males. All-cause 10-years mortality were higher in females after both CABG 1.15 (1.06–1.25) and PCI 1.17 (1.11–1.23), Males had marginally higher 10-years mortality after CABG compared to PCI (1.04 (1.00-1.10)), while no difference in females (1.03 (0.95–1.13)). Further, males had better survival than the background population, three years after both CABG and PCI, while females after PCI surpassed the population survival after six years but never reached the background population after CABG. Regarding the number of treated vessels/grafts single-PCI had lowest mortality followed by CABG, while 3-vessel PCI had the highest mortality. Conclusion Despite being referred for coronary diagnostication according to their IHD prevalence, females receive revascularization treatment less often and have a substantially higher mortality after revascularization than males.