A Gender-based analysis from the RAIN-CARDIOGROUP VII study (veRy thin stents for patients with left mAIn or bifurcatioN in real life) on Left-main stenting
Introduction. There is a lack of data on clinical outcomes of percutaneous coronary intervention (PCI) with ultrathin stents on unprotected left main (ULM) coronary artery both in women and men. Methods. All patients treated with ULM PCI with ultrathin stents (struts thinner than 81 µm) enrolled in the RAIN-cardiogroup VII Study were analysed according to a gender-assessment evaluation. Major adverse cardiovascular events (MACE: a composite of all cause death, myocardial infarction, target lesion revascularization [TLR] and stent thrombosis) were the primary end-point, whereas single components of MACE were the secondary end-points. Results. Out of a cohort of 793 patients, 172 (21.7%) women and 621 (78.3%) men were included. Compared to men, women were older and less frequently smokers, had more frequently a history of previous PCI and presented more frequently with an acute coronary syndrome. Among women, ostial lesions were more prevalent and mean diameter stent was lower compared to men. After 13.4 (8.4-21.6) months, 32 (18.6%) women and 106 (17.1%) men experienced MACE (p=0.64). Censoring follow-up data at 3 years, no differences were observed in MACE (16.9 vs 14.7 per 100*pts/years, log-rank p=0.61) and their single components between women and men. At multivariate analysis, chronic kidney disease (HR 1.91: 1.23 -2.95, p=0.004) and acute coronary syndrome presentation (HR 1.84: 1.22-2.77, p=0.013) were independent predictors of MACE overall. Larger stent size (HR 0.65, 95% CI 0.48-0.89, p=0.007) and longer double antiplatelet therapy duration (HR 0.95, 95% CI 0.90-0.99, p=0.032) were associated with a reduced risk of MACE during the subsequent follow-up Conclusion. Ultrathin stents offer low rates of MACE and TLR in the overall population without significant differences between sexes.