Sex Differences in Fractional Flow Reserve- or Intravascular Ultrasound-Guided Percutaneous Coronary Intervention.

BACKGROUND: A recent randomized trial reported fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) strategy was non-inferior to the intracoronary ultrasound (IVUS)-guided PCI strategy with respect to clinical outcomes with fewer revascularizations.

OBJECTIVES: Sex differences in treatment and clinical outcomes according to physiology- or imaging- guided percutaneous coronary intervention (PCI) strategies remain unclear.

METHODS: This secondary analysis of an investigator-initiated, international, randomized trial aimed to investigate the impact of sex on procedural characteristics, treatment, and clinical outcomes according to different strategies and treatment types (PCI vs. deferral of PCI). The primary outcome was target vessel failure (TVF) at 24 months, defined as a composite of cardiac death, target-vessel myocardial infarction, and target-vessel revascularization.

RESULTS: Of 1619 patients, 30% were women. Compared with men, women had a smaller minimal lumen area, smaller plaque burden, and higher FFR. They had a lower PCI rate (40.8% vs. 47.9%, p=0.008), which was mainly contributed by FFR guidance. Overall, women showed a lower TVF rate (2.4% vs. 4.5%). According to the treatment type, the cumulative incidence of TVF was lower in women than in men among those with the deferral of PCI (1.7% vs. 5.2%). However, this trend was not observed in patients who underwent PCI. In both women and men, there were no differences in clinical outcomes between the FFR- and IVUS-guided strategies.

CONCLUSIONS: In cases of intermediate stenosis, despite receiving fewer interventions, women had more favorable outcomes than men. The use of FFR led to a lower PCI rate but had a similar prognostic value compared to IVUS in both women and men.