Sex differences in cardiovascular outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention.

Background: Sex differences in acute coronary syndrome (ACS) presentation and outcomes have been increasingly recognized, yet data from Southeast Asian populations, particularly Thailand, remain limited. This study aimed to evaluate sex-specific differences in baseline characteristics, in-hospital mortality, and 1-year mortality among ACS patients undergoing percutaneous coronary intervention (PCI). Methods: This retrospective cohort study included 1,579 patients aged ≥18 years diagnosed with ACS who underwent PCI at King Chulalongkorn Memorial Hospital between January 2017 and October 2021. Baseline characteristics, post-procedural complications, and outcomes were compared between sexes. Primary outcomes were in-hospital and 1-year mortality. Secondary outcomes included post-procedural complications such as coronary artery complications, vascular complications, acute kidney injury, stroke, bleeding, and nosocomial infections. One-year mortality was analyzed using Cox proportional hazards models and Kaplan-Meier survival analysis. Results: Among the study population, 453 (28.7%) were women. Women were significantly older (median: 70 vs. 60 years, P<0.001) and had higher rates of hypertension, diabetes, coronary artery disease, and atrial fibrillation. They were more likely to present with dyspnea (12.1% vs. 7.3%, P=0.006) and less likely to have ST-elevation myocardial infarction (STEMI) (50.8% vs. 62.8%, P<0.001). In-hospital mortality rates were higher in women but did not reach statistical significance (7.5% vs. 5.4%, P=0.12), while 1-year mortality was significantly higher in women (21.6% vs. 12.8%, P<0.001). After adjusting for confounders, the hazard ratio for 1-year mortality in women remained elevated [hazard ratio (HR): 1.46; 95% confidence interval (CI): 1.10-1.93; P=0.009]. Women also experienced higher rates of acute kidney injury, major bleeding, and nosocomial infections. Conclusions: Women with ACS undergoing PCI presented with more comorbidities, atypical symptoms, and higher long-term mortality compared to men.