Sex Differences in Outcomes of Complete Versus Culprit-Only Revascularization in Patients with Acute Coronary Syndrome and Multivessel Coronary Artery Disease
This prospective single-center study of 105 patients with acute coronary syndrome and multivessel disease found that while complete and culprit-only revascularization were performed at similar rates in men and women, distinct sex-specific risk profiles emerged—characterized by higher metabolic comorbidities in women and exclusive tobacco/shisha use in men—and the extremely low one-month MACE rate (3.8%) precluded meaningful statistical comparisons of outcomes between sexes or strategies.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Heart attacks often strike when a single artery becomes blocked, but in many cases, the damage is part of a larger pattern where multiple arteries are narrowed or diseased. When doctors treat these patients, they face a critical choice: fix only the specific artery causing the immediate crisis, or take the opportunity to clear all the narrowed vessels during the same hospital stay. For years, major studies have suggested that clearing all the blockages leads to better long-term health, yet a significant question remained unanswered. Women have historically been left out of many of these major medical trials, and because their hearts and risk factors often differ from men's, doctors have wondered if the same treatment rules apply to them. Does the strategy that works best for men also work best for women, or do the two groups need different approaches?
A team of researchers at Tanta University Hospital in Egypt set out to answer this question by observing real patients as they received care. They followed 105 adults who had suffered an acute heart attack and were found to have disease in more than one major heart artery. The researchers divided these patients into groups based on their sex and the treatment they received. Some patients underwent complete revascularization, a procedure where doctors used a catheter to open every significant blockage in the heart during the hospital stay. Others received culprit-only revascularization, where doctors fixed only the specific artery responsible for the heart attack and left the other narrowed vessels for a later time or ignored them entirely. The team then watched these patients for one month after they left the hospital to see who experienced serious complications, such as a new heart attack, stroke, heart failure, or death.
The study revealed a striking contrast in the lives and health profiles of the men and women involved, even though they arrived at the hospital with similar heart problems. The men were overwhelmingly heavy users of tobacco, with more than eight out of ten smoking cigarettes or using shisha, a water pipe. In sharp contrast, almost none of the women in the study used tobacco in any form. Instead, the women carried a much heavier burden of metabolic disease; nearly six out of ten women had diabetes, compared to only about one-third of the men. Despite these vastly different risk factors, the doctors treated both sexes in the same way. The rate at which women received the complete treatment to fix all their arteries was almost identical to the rate for men. There was no evidence that doctors were holding back on treating women or that women were being treated differently because of their sex.
When the researchers looked at the health of the patients one month later, the results were reassuring but limited by the small number of people involved. Very few patients in the entire group suffered a major bad event; only four people out of the 105 experienced a serious complication like a new heart attack or stroke. Because the number of events was so small, the researchers could not say with certainty whether one treatment strategy was better than the other, or whether men and women had different outcomes. The study found no statistical difference in survival or complication rates between the sexes or between the two treatment approaches during that short month. The authors noted that the one-month window was likely too brief to see the long-term benefits that other large studies have found with clearing all arteries, and the small size of the group meant the results were more of a snapshot than a final verdict.
What this research does clearly show is that in this specific hospital setting, women with multiple blocked arteries were not being treated differently than men. They received the same aggressive care to clear their arteries, regardless of their different risk profiles. The study highlights that while men and women in this population face very different causes for their heart disease—men driven largely by tobacco use and women by diabetes—the medical response to the blockages themselves appeared consistent. The findings suggest that the gap in treatment between men and women may be closing in some areas, but they also underscore the need for larger studies with longer follow-up periods to truly understand how these different strategies play out over time for both sexes.
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