Skip to main content
SpringerLink
Log in

Gender-related differences in clinical outcomes after either single or double left main bifurcation stenting

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

We sought to examine the impact of gender differences in clinical outcomes at 3 years also comparing the role of double versus single stenting approach for the treatment of coronary unprotected LM bifurcation lesions. We retrospectively analyzed both the procedural and medical data of patients referred to our hub center for complex LM bifurcation disease, treated using Crossover provisional stenting, T or T-and-Protrusion (TAP), Culotte, and Nano-inverted-T (NIT) techniques between January 1st, 2008 and May 1st 2018. The main outcome of the study was to evaluate the association between gender and target lesion failure (TLF) based on the different stenting technique used. Five hundred and sixty-seven patients (251 females, mean age 70.0 ± 10 years, mean Syntax score 31.6 ± 6.3) were evaluated. Crossover, T or TAP, culotte and NIT techniques were performed in 171 (30.1%), 61 (10.7%), 98 (17.2%) and 237 (41.8%) patients, respectively with no differences in baseline and peri-procedural items among gender. At a mean follow-up of 37.1 ± 10.8 months (range 22.1–39.3 moths), the overall TLF rate, cardiovascular mortality and stent thrombosis were 12.1%, 3.1% and 1.0%, respectively. Female gender was associated with an increased rate of major bleeding when treated with double stent strategy (p = 0.02). No gender difference in TLF was noted among gender, independently from the stenting approach used. Among patients with ULM bifurcation disease undergoing PCI, TLF rates were not different between genders at 3-year follow-up either using a single or double stent technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2015) Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation 131:e29-322

    Article  Google Scholar 

  2. Vaccarino V, Badimon L, Corti R, de Wit C, Dorobantu M, Hall A, Koller A, Marzilli M, Pries A, Bugiardini R, Working Group on Coronary Pathophysiology and Microcirculation (2011) Ischaemic heart disease in women: are there sex differences in pathophysiology and risk factors? Position paper from the working group on coronary pathophysiology and microcirculation of the European Society of Cardiology. Cardiovasc Res 90:9–17

    Article  CAS  Google Scholar 

  3. Shaw LJ, Bugiardini R, Merz CN (2009) Women and ischemic heart disease: evolving knowledge. J Am Coll Cardiol 54:1561–1575

    Article  Google Scholar 

  4. Guo Y, Yin F, Fan C, Wang Z (2018) Gender difference in clinical outcomes of the patients with coronary artery disease after percutaneous coronary intervention: a systematic review and meta-analysis. Medicine (Baltimore) 97:e11644

    Article  Google Scholar 

  5. Kim HL, Jang JS, Kim MA, Seo JB, Chung WY, Kim SH, Park SJ, Youn TJ, Yoon MH, Lee JH, Chang K, Jeong MH, Choi RK, Hong MK, Kim HS (2019) Gender differences of in-hospital outcomes in patients undergoing percutaneous coronary intervention in the drug-eluting stent era. Medicine (Baltimore) 98:e15557

    Article  CAS  Google Scholar 

  6. Roumeliotis A, Claessen BE, Sartori S, Cao D, Qiu H, Camaj A, Nicolas J, Chandiramani R, Goel R, Chiarito M, Torguson R, Sweeny J, Barman N, Krishnan P, Kini A, Sharma SK, Dangas G, Mehran RR (2021) Impact of sex on long-term cardiovascular outcomes of patients undergoing percutaneous coronary intervention for acute coronary syndromes. Catheter Cardiovasc Interv 98:E494–E500

    PubMed  Google Scholar 

  7. De Rosa R, Morici N, De Luca G, De Luca L, Ferri LA, Piatti L, Tortorella G, Grosseto D, Franco N, Misuraca L, Sganzerla P, Cacucci M, Antonicelli R, Cavallini C, Lenatti L, Leuzzi C, Murena E, Ravera A, Ferrario M, Corrada E, Colombo D, Prati F, Piscione F, Petronio AS, Galasso G, De Servi S, Savonitto S, Italian Elderly ACS Collaboration (2021) Association of sex with outcome in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention. Am J Med 134:1135-1141.e1

    Article  Google Scholar 

  8. Schamroth Pravda N, Perl L, Greenberg G, Codner P, Assali A, Samara A, Porter A, Kornowski R, Vaknin-Assa H (2021) Impact of sex on outcomes of bifurcation lesion percutaneous coronary intervention: results from a single-centre prospective registry. Coron Artery Dis. https://doi.org/10.1097/MCA.0000000000001039

    Article  Google Scholar 

  9. Mäkikallio T, Holm NR, Lindsay M, Spence MS, Erglis A, Menown IB, Trovik T, Eskola M, Romppanen H, Kellerth T, Ravkilde J, Jensen LO, Kalinauskas G, Linder RB, Pentikainen M, Hervold A, Banning A, Zaman A, Cotton J, Eriksen E, Margus S, Sørensen HT, Nielsen PH, Niemelä M, Kervinen K, Lassen JF, Maeng M, Oldroyd K, Berg G, Walsh SJ, Hanratty CG, Kumsars I, Stradins P, Steigen TK, Fröbert O, Graham AN, Endresen PC, Corbascio M, Kajander O, Trivedi U, Hartikainen J, Anttila V, Hildick-Smith D, Thuesen L, Christiansen EH, NOBLE study investigators (2016) Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet 388:2743–2752

    Article  Google Scholar 

  10. Stone GW, Sabik JF, Serruys PW, Simonton CA, Généreux P, Puskas J, Kandzari DE, Morice MC, Lembo N, Brown WM 3rd, Taggart DP, Banning A, Merkely B, Horkay F, Boonstra PW, van Boven AJ, Ungi I, Bogáts G, Mansour S, Noiseux N, Sabaté M, Pomar J, Hickey M, Gershlick A, Buszman P, Bochenek A, Schampaert E, Pagé P, Dressler O, Kosmidou I, Mehran R, Pocock SJ, Kappetein AP, EXCEL Trial Investigators (2016) Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med 375:2223–2235

    Article  CAS  Google Scholar 

  11. Head SJ, Milojevic M, Daemen J, Ahn JM, Boersma E, Christiansen EH, Domanski MJ, Farkouh ME, Flather M, Fuster V, Hlatky MA, Holm NR, Hueb WA, Kamalesh M, Kim YH, Mäkikallio T, Mohr FW, Papageorgiou G, Park SJ, Rodriguez AE, Sabik JF 3rd, Stables RH, Stone GW, Serruys PW, Kappetein AP (2018) Stroke rates following surgical versus percutaneous coronary revascularization. J Am Coll Cardiol 72:386–398

    Article  Google Scholar 

  12. Gaudino M, Hameed I, Farkouh ME, Rahouma M, Naik A, Robinson NB, Ruan Y, Demetres M, Biondi-Zoccai G, Angiolillo DJ, Bagiella E, Charlson ME, Benedetto U, Ruel M, Taggart DP, Girardi LN, Bhatt DL, Fremes SE (2020) Overall and cause-specific mortality in randomized clinical trials comparing percutaneous interventions with coronary bypass surgery: a meta-analysis. JAMA Intern Med 180:1638–1646

    Article  Google Scholar 

  13. Park S, Ahn JM, Park H, Kang DY, Lee PH, Kim TO, Lee J, Kim JH, Yang Y, Jeong YJ, Hyun J, Kim AR, Kim T, Oh HJ, Lee YJ, Lee JH, Jang M, Park DW, Park SJ, IRIS-MAIN Registry Investigators (2021) Comparison of long-term outcomes following coronary revascularization in men-vs-women with unprotected left main disease. Am J Cardiol 153:9–19

    Article  Google Scholar 

  14. Kałużna-Oleksy M, Skorupski WJ, Grygier M, Araszkiewicz A, Skorupski W, Grajek S, Mitkowski P, Pyda M, Lesiak M (2021) A personalized approach to percutaneous coronary interventions in the left main coronary artery-is the female gender associated with worse outcomes? J Pers Med 11:581

    Article  Google Scholar 

  15. Banning AP, Lassen JF, Burzotta F, Lefèvre T, Darremont O, Hildick-Smith D, Louvard Y, Stankovic G (2019) Percutaneous coronary intervention for obstructive bifurcation lesions: the 14th consensus document from the European Bifurcation Club. EuroIntervention 15:90–98

    Article  Google Scholar 

  16. Ad N, Holmes SD, Patel J, Pritchard G, Shuman DJ, Halpin L (2016) Comparison of EuroSCORE II, original EuroSCORE, and the society of thoracic surgeons risk score in cardiac surgery patients. Ann ThorSurg 102:573–579

    Article  Google Scholar 

  17. Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, van den Brand M, Van Dyck N, Russell ME, Mohr FW, Serruys PW (2005) The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 1:219–227

    PubMed  Google Scholar 

  18. Medina A, Suarez de Lezo J, Pan MA (2006) New classification of coronary bifurcation lesions. Rev EspCardiol 59:183

    Google Scholar 

  19. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, ESC Scientific Document Group (2019) Fourth universal definition of myocardial infarction (2018). Eur Heart J 40:237–269

    Article  Google Scholar 

  20. Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ, Satler LF, Pichard AD, Kent KM, Stone GW, Leon MB (1999) Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation 100:1872–1878

    Article  CAS  Google Scholar 

  21. Osman M, Ghaffar YA, Osman K, Kheiri B, Mohamed MMG, Kawsara A, Balla S, Roda-Renzelli A, Daggubati R (2021) Gender-based outcomes of coronary bifurcation stenting: a report from the National Readmission Database. Catheter Cardiovasc Interv. https://doi.org/10.1002/ccd.29704

    Article  PubMed  Google Scholar 

  22. Rigatelli G, Zuin M, Ronco F, Caprioglio F, Cavazzini D, Giatti S, Braggion G, Perilli S, Nguyen VT (2018) Usefulness of the Finet law to guide stent size selection in ostial left main stenting: comparison with standard angiographic estimation. CardiovascRevasc Med 19:751–754

    Google Scholar 

  23. Grayson AD, Moore RK, Jackson M, Rathore S, Sastry S, Gray TP, Schofield I, Chauhan A, Ordoubadi FF, Prendergast B, Stables RH, North West Quality Improvement Programme in Cardiac Interventions (2006) Multivariate prediction of major adverse cardiac events after 9914 percutaneous coronary interventions in the north west of England. Heart 92:658–663

    Article  CAS  Google Scholar 

  24. Zhang L, Wang Z, Liu X, Zhou Z, Zhao Y, Shi D, Liu Y, Liang J, Yang L, Chai M, Zhou Y (2016) Women with early menopause have higher rates of target lesion revascularization after percutaneous coronary intervention. Angiology 67:311–316

    Article  CAS  Google Scholar 

  25. Vogel B, Baber U, Cohen DJ, Sartori S, Sharma SK, Angiolillo DJ, Farhan S, Goel R, Zhang Z, Briguori C, Collier T, Dangas G, Dudek D, Escaned J, Gil R, Han YL, Kaul U, Kornowski R, Krucoff MW, Kunadian V, Mehta SR, Moliterno D, Ohman EM, Sardella G, Witzenbichler B, Gibson CM, Pocock S, Huber K, Mehran R (2021) Sex differences among patients with high risk receiving ticagrelor with or without aspirin after percutaneous coronary intervention: a subgroup analysis of the TWILIGHT randomized clinical trial. JAMA Cardiol 6:1032–1041

    Article  Google Scholar 

  26. Murphy AC, Dinh D, Koshy AN, Lefkovits J, Clark DJ, Zaman S, Duffy SJ, Brennan A, Reid C, Yudi MB, Registry VCO (2021) Comparison of long-term outcomes in men versus women undergoing percutaneous coronary intervention. Am J Cardiol 153:1–8

    Article  Google Scholar 

  27. Lansky AJ, Costa RA, Mooney M, Midei MG, Lui HK, Strickland W, Mehran R, Leon MB, Russell ME, Ellis SG et al (2005) Gender-based outcomes after paclitaxel-eluting stent implantation in patients with coronary artery disease. J Am Coll Cardiol 45:1180–1185

    Article  CAS  Google Scholar 

  28. Solinas E, Nikolsky E, Lansky AJ, Kirtane AJ, Morice MC, Popma JJ, Schofer J, Schampaert E, Pucelikova T, Aoki J et al (2007) Gender-specific outcomes after sirolimus-eluting stent implantation. J Am Coll Cardiol 50:2111–2116

    Article  CAS  Google Scholar 

  29. Mikhail GW, Gerber RT, Cox DA, Ellis SG, Lasala JM, Ormiston JA, Stone GW, Turco MA, Joshi AA, Baim DS et al (2010) Influence of sex on long-term outcomes after percutaneous coronary intervention with the paclitaxel-eluting coronary stent: results of the “TAXUSWoman” analysis. JACC Cardiovasc Interv 3:1250–1259

    Article  Google Scholar 

  30. Rigatelli G, Zuin M, Nikolov P, Mileva N, Vassilev D (2021) One- and 3-year outcomes of percutaneous bifurcation left main revascularization with modern drug-eluting stents: a systematic review and meta-analysis. Clin Res Cardiol 110:1–11

    Article  Google Scholar 

  31. Ishida M, Takahashi F, Goto I, Niiyama M, Saitoh H, Sakamoto T, Maegawa Y, Osaki T, Nishiyama O, Endo H, Sakamoto R, Kojima T, Koeda Y, Kimura T, Itoh T, Morino Y, REIWA investigators (2020) Clinical outcomes of patients treated using very short duration dual antiplatelet therapy after implantation of biodegradable-polymer drug-eluting stents: rationale and design of a prospective multicenter REIWA registry. Cardiovasc Interv Ther 35:398–404

    Article  CAS  Google Scholar 

Download references

Funding

None.

Author information

Author notes

  1. Gianluca Rigatelli and Marco Zuin equally contributed as first author.

Authors and Affiliations

  1. Division of Cardiology, Department of Specialistic Medicine, Rovigo General Hospital, Viale Tre Martiri 140, 45100, Rovigo, Italy

    Gianluca Rigatelli, Claudio Picariello, Filippo Gianese, Sabrina Osti & Loris Roncon

  2. Department of Translational Medicine, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Ferrara, Italy

    Marco Zuin

  3. Department of Internal Medicine, Rovigo General Hospital, Rovigo, Italy

    Alberto Mazza

  4. Head of Cardiology, Alexandroska University Hospital Medical School, Sofia, Bulgaria

    Dobrin Vassilev

  5. Department of Interventional Cardiology, Tam Duc Heart Hospital, Ho Chi Minh City, Vietnam

    Huy Dinh

  6. Department of Interventional Cardiology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam

    Nguyen Van Tan

  7. Department of Interventional Cardiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam

    Nguyen Nghia

Authors
  1. Gianluca Rigatelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Zuin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claudio Picariello
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Filippo Gianese
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sabrina Osti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alberto Mazza
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dobrin Vassilev
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Huy Dinh
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nguyen Van Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Nguyen Nghia
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Loris Roncon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gianluca Rigatelli.

Ethics declarations

Conflict of interest

None of the authors have conflicts of interest to declare.

Ethical approval

Ethical approval was waived by the local Ethics Committee of University A in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rigatelli, G., Zuin, M., Picariello, C. et al. Gender-related differences in clinical outcomes after either single or double left main bifurcation stenting. Heart Vessels 37, 1326–1336 (2022). https://doi.org/10.1007/s00380-022-02038-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-022-02038-7

Keywords

Search

Navigation