Abstract 4145353: Sex Differences in Post-PCI Myocardial Injury and Long-Term All-Cause Mortality

Background: Myocardial injury complicating percutaneous coronary intervention (PCI) is associated with mortality, but sex differences in outcomes are uncertain. We explored sex differences in the incidence and long-term outcomes of post-PCI myocardial injury (PPMI). Methods: Adults who underwent PCI at NYU between 2011-2020 were included in this retrospective analysis. Patients with ACS as the indication for PCI were excluded. PPMI was defined as a peak CKMB concentration >99% of the upper reference limit. The incidence of PPMI by sex was compared by Chi-square tests. Independent predictors of elevated CKMB post-PCI were evaluated with linear regression models in subgroups by sex. Cox proportional hazard models were generated to evaluate relationships between PPMI and all-cause mortality by sex. Results: Of 10,807 adults undergoing PCI, 24.9% (2,694) were female. Females were older than males at the time of PCI (68.9 vs. 65.8, p<0.001), more likely to have stage ≥3 CKD (30.3% vs. 23.9%, p<0.001), and had shorter target lesion lengths (mean 24.6mm ± 18.3 vs 28.1mm ± 20.5, p<0.001). PPMI was less common among females than males (14.1% vs. 17.7%, p<0.001). Among females, older age, longer lesion length, multivessel PCI, severe vessel calcification, and thrombectomy device use were independently associated with higher post-PCI CKMB concentrations. Among males, older age, longer lesion length, vessel calcification, and atherectomy device use were associated with higher post-PCI CKMB concentrations. Over 4.3 year mean follow-up, 131 (4.9%) females and 341 (4.2%) males died. Males with PPMI had a greater risk of long-term death than males without PPMI (p<0.001) (Figure 1), while in females PPMI was associated with a trend towards excess mortality that did not reach statistical significance (p=0.064). No significant sex interaction was observed in the association between PPMI and mortality (p=0.38). Conclusions: In this large, single-center experience, female patients had less extensive coronary artery disease and were less likely to develop PPMI than males. Myocardial injury was associated with higher long-term mortality overall and among males with no significant interactions between sex and mortality.