Sex differences in clinical outcomes following percutaneous coronary intervention of unprotected left main coronary artery: A systematic review and meta-analysis

Introduction: Percutaneous coronary intervention (PCI) has emerged as a reasonable alternative to coronary artery bypass graft (CABG) surgery in well-selected patients with unprotected left main coronary disease (LMCD). We conducted a systematic review and meta-analysis with the aim of assessing the impact of sex on outcomes of PCI in patients with unprotected LMCD. Methods: A systematic search of PUBMED, EMBASE, Cochrane, and Google Scholar databases was performed to identify studies comparing the outcomes of men vs. women among patients undergoing PCI for unprotected LMCD. The primary outcome of interest was study defined major adverse cardiac events (MACE) and secondary outcomes were all-cause mortality, cardiac mortality, myocardial infarction (MI), target lesion revascularization (TLR), stent thrombosis and stroke. For all outcomes, pooled odds ratios (OR) with their corresponding 95% confidence intervals (CIs) were calculated using the DerSimonian-Laird random-effects model. Results: Six studies with a total of 6515 individuals (4954 men, 1561women) with a mean follow up of 36 months were included in the analysis. MACE and MI were significantly higher in women with OR of 1.17 (95% CI 1.01–1.36; p = 0.03) and 1.42 (95% CI 1.07–1.87; p = 0.01) respectively. All-cause mortality, cardiac mortality, and TLR were similar among men and women. Conclusion: Our meta-analysis suggests that women undergoing PCI for unprotected LMCD have higher rates of MACE and MI compared to men.