Figure 1
The flow chart of the study. MT, medical therapy; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; MACCE: major adverse cardiac and cerebrovascular events.
Table 1
Baseline Characteristics.
| PARAMETERS | ENTIRE COHORT (n = 8943) | MEN (n = 7122) | WOMEN (n = 1821) | P VALUE |
|---|---|---|---|---|
| Demographic characteristics | ||||
| Age (years) | 61.1 ± 10.0 | 60.0 ± 10.1 | 65.3 ± 8.1 | <0.001 |
| BMI (kg/m2) | 25.8 ± 3.1 | 25.9 ± 3.0 | 25.5 ± 3.3 | <0.001 |
| Past medical history | ||||
| Previous MI | 3184 (35.6) | 2735 (38.4) | 449 (24.7) | <0.001 |
| Previous stroke | 888 (9.9) | 699 (9.8) | 189 (10.4) | 0.500 |
| Hypertension | 6055 (67.7) | 4628 (65.0) | 1427 (78.4) | <0.001 |
| Hyperlipidaemia | 5005 (56.0) | 3958 (56.0) | 1047 (57.5) | 0.148 |
| Diabetes | 3117 (34.9) | 2333 (32.8) | 784 (43.1) | <0.001 |
| COPD | 100 (1.1) | 81 (1.1) | 19 (1.0) | 0.830 |
| PAD | 690 (7.7) | 546 (7.7) | 144 (7.9) | 0.768 |
| Previous PCI | 1131 (12.7) | 971 (13.6) | 160 (8.8) | <0.001 |
| Previous CABG | 307 (3.4) | 259 (3.6) | 48 (2.6) | 0.043 |
| Current/former smoker | 4981 (55.7) | 4711 (66.2) | 270 (14.8) | <0.001 |
| Clinical presentation | 0.002 | |||
| SAP | 3506 (39.2) | 2849 (40.0) | 657 (36.1) | |
| ACS | 5437 (60.8) | 4273 (60.0) | 1164 (63.9) | |
| LVEF (%) | 58.2 ± 9.8 | 58.0 ± 9.9 | 59.2 ± 9.5 | <0.001 |
| Laboratory examination | ||||
| TC (mmol/L) | 4.6 ± 1.1 | 4.5 ± 1.0 | 4.9 ± 1.2 | <0.001 |
| HDL-C (mmol/L) | 1.0 ± 0.3 | 1.0 ± 0.3 | 1.1 ± 0.3 | <0.001 |
| LDL-C (mmol/L) | 2.6 ± 0.9 | 2.5 ± 0.9 | 2.7 ± 0.9 | <0.001 |
| CCr (mL/min)a | 85.5 ± 26.8 | 88.7 ± 26.7 | 72.7 ± 23.1 | <0.001 |
| Angiographic characteristics | ||||
| Left main involvement | 2063 (23.1) | 1684 (23.7) | 379 (20.8) | 0.011 |
| SYNTAX scoreb | 25.3 ± 11.2 | 25.3 ± 11.5 | 25.1 ± 10.0 | 0.504 |
| Treatment strategies | ||||
| MT alone | 2421 (27.1) | 1869 (26.2) | 552 (30.3) | 0.001 |
| PCI | 3825 (42.8) | 3059 (43.0) | 766 (42.1) | |
| CABG | 2697 (30.2) | 2194 (30.8) | 503 (27.6) | |
| Medication at discharge | ||||
| Aspirin | 8540 (95.5) | 6803 (95.5) | 1737 (95.4) | 0.855 |
| Clopidogrel | 4670 (52.2) | 3739 (52.5) | 931 (51.1) | 0.307 |
| ACEI | 3309 (37.0) | 2664 (37.4) | 645 (35.4) | 0.124 |
| ARB | 1358 (15.2) | 1001 (14.1) | 357 (19.6) | <0.001 |
| Nitrate | 8288 (92.7) | 6614 (92.9) | 1674 (91.9) | 0.170 |
| Beta-blocker | 7858 (87.9) | 6242 (87.6) | 1616 (88.7) | 0.215 |
| CCB | 3229 (36.1) | 2440 (34.3) | 789 (43.3) | <0.001 |
| Statin | 5982 (66.9) | 4737 (66.5) | 1245 (68.4) | 0.140 |
[i] Values are presented as mean ± standard deviation or number (%).
ACEI, angiotensin-converting enzyme inhibitors; ACS, acute coronary syndrome; ARB, angiotensin II receptor blockers; BMI, body mass index; CABG, coronary artery bypass grafting; CCB, calcium channel blocker; CCr, creatinine clearance; COPD, chronic obstructive pulmonary disease; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TC, total cholesterol; LVEF, left ventricular ejection fraction; MI, myocardial infarction; MT, medical therapy; PAD, peripheral artery disease; PCI, percutaneous coronary intervention; SAP, stable angina pectoris.
aCalculated using the Cockcroft and Gault formula.
bCalculated using an online calculator (http://www.syntaxscore.com) by a dedicated research group blinded to the clinical data.
Figure 2
Incidences of clinical outcomes according to sex in the entire cohort and treatment strategy stratification. Incidence of all-cause death (A) and incidence of MACCE (B). MT, medical therapy; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; MACCE: major adverse cardiac and cerebrovascular events.
Figure 3
Ten-year cumulative event curves between men and women in the entire cohort from crude data. Crude cumulative incidence of all-cause death (A). Crude cumulative incidence of MACCE (B). MACCE: major adverse cardiac and cerebrovascular events.
Table 2
The Effect of Sex on Long-term Clinical Outcomes in Patients with TVD in the Entire Cohort and Treatment Strategy Stratification.
| CLINICAL OUTCOMES | WOMEN VS. MEN | ADJUSTED HR (95% CI) | P VALUE |
|---|---|---|---|
| All-cause death | Entire Cohort | 0.777 (0.670–0.901) | 0.001 |
| MT alone group | 0.872 (0.706–1.077) | 0.204 | |
| PCI group | 0.702 (0.538–0.915) | 0.009 | |
| CABG group | 0.708 (0.504–0.996) | 0.047 | |
| P for interaction | 0.312 | ||
| MACCE | Entire Cohort | 0.870 (0.777–0.974) | 0.016 |
| MT alone group | 0.916 (0.764–1.099) | 0.345 | |
| PCI group | 0.821 (0.681–0.989) | 0.037 | |
| CABG group | 0.922 (0.730–1.166) | 0.499 | |
| P for interaction | 0.228 |
[i] MT, medical therapy; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; MACCE: major adverse cardiac and cerebrovascular events; HR, hazard ratio; CI, confidence interval.
Figure 4
Ten-year cumulative events curves between men and women in the entire cohort from multivariable-adjusted data. Adjusted cumulative incidence of all-cause death (A). Adjusted cumulative incidence of MACCE (B). MACCE: major adverse cardiac and cerebrovascular events; HR, hazard ratio; CI, confidence interval. The covariates adjusted were: sex, age, body mass index, diabetes, hyperlipidemia, chronic obstructive pulmonary disease, peripheral artery disease, previous myocardial infarction, previous stroke, previous PCI, previous CABG, acute coronary syndrome, left main coronary disease, left ventricular ejection fraction, creatinine clearance, baseline SYNTAX score, and treatment strategies (MT alone, PCI, or CABG).
| ACS | acute coronary syndrome |
| CABG | coronary artery bypass grafting surgery |
| CHD | coronary heart disease |
| CI | confidence interval |
| HR | hazard ratio |
| MVD | multi-vessel coronary disease |
| MT | medical therapy |
| MACCE | major adverse cardiac and cerebrovascular events |
| MI | myocardial infarction |
| PCI | percutaneous coronary intervention |
| TVD | three-vessel coronary disease |