Sex Differences in Cardiovascular Outcomes of Intravascular Imaging-Guided PCI
Background: Disparities in cardiovascular disease presentation and outcomes between men and women are well-documented. While intravascular imaging (IVI) improves percutaneous coronary intervention (PCI) outcomes, its potential sex-specific benefits remain unclear. Objectives: The purpose of this stu...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-09-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X25005010 |
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| author | Chidubem Ezenna, MD, BS Sammudeen Ibrahim, MD Prasana Ramesh, MD Mahmoud Ismayl, MBBS Mrinal Murali Krishna, MBBS Meghna Joseph, MBBS Kuan-Yu Chi, MD S. Elissa Altin, MD Michael G. Nanna, MD, MHS Andrew M. Goldsweig, MD, MS |
| author_facet | Chidubem Ezenna, MD, BS Sammudeen Ibrahim, MD Prasana Ramesh, MD Mahmoud Ismayl, MBBS Mrinal Murali Krishna, MBBS Meghna Joseph, MBBS Kuan-Yu Chi, MD S. Elissa Altin, MD Michael G. Nanna, MD, MHS Andrew M. Goldsweig, MD, MS |
| author_sort | Chidubem Ezenna, MD, BS |
| collection | DOAJ |
| description | Background: Disparities in cardiovascular disease presentation and outcomes between men and women are well-documented. While intravascular imaging (IVI) improves percutaneous coronary intervention (PCI) outcomes, its potential sex-specific benefits remain unclear. Objectives: The purpose of this study was to determine sex differences in adverse cardiovascular events in coronary artery disease patients undergoing PCI with IVI guidance vs angiography alone. Methods: Systematic review of PubMed, Scopus, and Cochrane databases was conducted to identify randomized controlled trials comparing major adverse cardiovascular events (MACE) in men and women with coronary artery disease (presenting with acute or chronic coronary syndrome) undergoing IVI-guided vs angiography-guided PCI. Risk ratios (RRs) with 95% CIs were calculated using random-effects models. Results: Eight randomized controlled trials, comprising 14,812 patients (76.1% men and 23.9% women) were included. IVI-guided PCI significantly reduced MACE in both men (RR: 0.69; 95% CI: 0.58-0.81; P < 0.001) and women (RR: 0.64; 95% CI: 0.49-0.82; P < 0.001) compared with angiography alone (Pinteraction = 0.62). Intravascular ultrasound–guided PCI reduced MACE in men and women compared with angiography alone (Pinteraction = 0.86). Optical coherence tomography–guided PCI reduced MACE in men but not in women compared with angiography alone (Pinteraction = 0.86). Conclusions: Despite the underrepresentation of women in IVI-guided PCI trials, this meta-analysis demonstrates that IVI-guided PCI confers a comparable reduction in MACE for both men and women, suggesting its potential to mitigate the long-standing sex-specific disparities in coronary intervention outcomes and supports its broader implementation in clinical practice. |
| format | Article |
| id | doaj-art-9c834ed9bba2474792431d6b26ffb06d |
| institution | Kabale University |
| issn | 2772-963X |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JACC: Advances |
| spelling | doaj-art-9c834ed9bba2474792431d6b26ffb06d2025-08-20T03:46:54ZengElsevierJACC: Advances2772-963X2025-09-014910207610.1016/j.jacadv.2025.102076Sex Differences in Cardiovascular Outcomes of Intravascular Imaging-Guided PCIChidubem Ezenna, MD, BS0Sammudeen Ibrahim, MD1Prasana Ramesh, MD2Mahmoud Ismayl, MBBS3Mrinal Murali Krishna, MBBS4Meghna Joseph, MBBS5Kuan-Yu Chi, MD6S. Elissa Altin, MD7Michael G. Nanna, MD, MHS8Andrew M. Goldsweig, MD, MS9Department of Medicine, University of Massachusetts – Baystate Medical Center, Springfield, Massachusetts, USA; Address for correspondence: Dr Chidubem Ezenna, Baystate Medical Center, 759 Chestnut Street, Springfield, Massachusetts 01199, USA.Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USADepartment of Medicine, University of Massachusetts – Baystate Medical Center, Springfield, Massachusetts, USADepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USADepartment of Medicine, Medical College Thiruvananthapuram, Trivandrum, Kerala, IndiaDepartment of Medicine, Medical College Thiruvananthapuram, Trivandrum, Kerala, IndiaDepartment of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USASection of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USASection of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USADepartment of Cardiovascular Medicine, Baystate Medical Center and Division of Cardiovascular Medicine, University of Massachusetts-Baystate, Springfield, Massachusetts, USABackground: Disparities in cardiovascular disease presentation and outcomes between men and women are well-documented. While intravascular imaging (IVI) improves percutaneous coronary intervention (PCI) outcomes, its potential sex-specific benefits remain unclear. Objectives: The purpose of this study was to determine sex differences in adverse cardiovascular events in coronary artery disease patients undergoing PCI with IVI guidance vs angiography alone. Methods: Systematic review of PubMed, Scopus, and Cochrane databases was conducted to identify randomized controlled trials comparing major adverse cardiovascular events (MACE) in men and women with coronary artery disease (presenting with acute or chronic coronary syndrome) undergoing IVI-guided vs angiography-guided PCI. Risk ratios (RRs) with 95% CIs were calculated using random-effects models. Results: Eight randomized controlled trials, comprising 14,812 patients (76.1% men and 23.9% women) were included. IVI-guided PCI significantly reduced MACE in both men (RR: 0.69; 95% CI: 0.58-0.81; P < 0.001) and women (RR: 0.64; 95% CI: 0.49-0.82; P < 0.001) compared with angiography alone (Pinteraction = 0.62). Intravascular ultrasound–guided PCI reduced MACE in men and women compared with angiography alone (Pinteraction = 0.86). Optical coherence tomography–guided PCI reduced MACE in men but not in women compared with angiography alone (Pinteraction = 0.86). Conclusions: Despite the underrepresentation of women in IVI-guided PCI trials, this meta-analysis demonstrates that IVI-guided PCI confers a comparable reduction in MACE for both men and women, suggesting its potential to mitigate the long-standing sex-specific disparities in coronary intervention outcomes and supports its broader implementation in clinical practice.http://www.sciencedirect.com/science/article/pii/S2772963X25005010sex differencescardiovascular outcomesintravascular imagingpercutaneous coronary interventionintravascular ultrasoundoptical coherence tomography |
| spellingShingle | Chidubem Ezenna, MD, BS Sammudeen Ibrahim, MD Prasana Ramesh, MD Mahmoud Ismayl, MBBS Mrinal Murali Krishna, MBBS Meghna Joseph, MBBS Kuan-Yu Chi, MD S. Elissa Altin, MD Michael G. Nanna, MD, MHS Andrew M. Goldsweig, MD, MS Sex Differences in Cardiovascular Outcomes of Intravascular Imaging-Guided PCI JACC: Advances sex differences cardiovascular outcomes intravascular imaging percutaneous coronary intervention intravascular ultrasound optical coherence tomography |
| title | Sex Differences in Cardiovascular Outcomes of Intravascular Imaging-Guided PCI |
| title_full | Sex Differences in Cardiovascular Outcomes of Intravascular Imaging-Guided PCI |
| title_fullStr | Sex Differences in Cardiovascular Outcomes of Intravascular Imaging-Guided PCI |
| title_full_unstemmed | Sex Differences in Cardiovascular Outcomes of Intravascular Imaging-Guided PCI |
| title_short | Sex Differences in Cardiovascular Outcomes of Intravascular Imaging-Guided PCI |
| title_sort | sex differences in cardiovascular outcomes of intravascular imaging guided pci |
| topic | sex differences cardiovascular outcomes intravascular imaging percutaneous coronary intervention intravascular ultrasound optical coherence tomography |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X25005010 |
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