Time Trends in Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention Meta-Analysis on Sex Differences

BACKGROUND Percutaneous coronary intervention (PCI) is considered the procedure of choice for patients with acute coronary syndrome (ACS), as it significantly improves cardiovascular outcomes. However, considerable uncertainty persists regarding the potential sex differences in PCI outcomes, due to conflicting results in previous studies. OBJECTIVES This meta-analysis aims to evaluate potential sex-related differences in cardiovascular adverse outcomes after PCI among ACS patients. METHODS The primary outcome was major adverse cardiovascular events (MACE) and its components. Outcomes were examined in various time frames including: short-term (within 1 month after PCI), mid-term (within 1 year), and long-term (within >1 year). A random effects model was used to estimate risk ratios (RR) and 95% CIs. RESULTS Among 32 trials, at short-term, PCI was associated with a higher risk of MACE (risk ratio [RR]: 1.43; 95% CI: 1.10-1.86), all-cause mortality (RR: 2.51; 95% CI: 1.70-3.71), and myocardial infarction (RR: 1.33; 95% CI: 1.00-1.77) in women compared with men. Over the long-term, women had a higher risk of MACE (RR: 1.11; 95% CI: 1.01-1.22), all-cause mortality (RR: 1.29; 95% CI: 1.17-1.42), and cardiovascular mortality (RR: 1.30; 95% CI: 1.11-1.52), when compared with men. However, the analysis for stroke and repeat revascularization showed no significant difference between the 2 groups in the long-and short-term. CONCLUSIONS In the meta-analysis of PCI-related trials in ACS, women have a higher risk of adverse cardiovascular outcomes compared with men. (JACC Adv. 2025;4:101526)(c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).