Sex disparities in coronary re-vascularisation and mortality

Sex disparities in coronary re-vascularisation and mortality | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sex disparities in coronary re-vascularisation and mortality Rajesh Bhavsar, Mariann Tang, Leif Thuesen, Gundhild Kjaergaard-Andersen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7657148/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Mar, 2026 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 9 You are reading this latest preprint version Abstract Introduction Ischemic heart disease (IHD) is, despite improvement last decades, still a leading cause of death globally. Clinical IHD guidelines do not distinguish between genders, although females experience higher mortality. This study aimed to investigate gender and procedure disparities after revascularization in patients with chronic coronary syndrome (CCS) and further correlate findings to the background population mortality. Methods The study included 40,565 first entry revascularizations by CABG or PCI from 2000–2020 obtained from Western Denmark Heart Registry. Kaplan-Meier survival curves evaluated mortality and re-intervention free survival, and logistic regression analysed the impact of identified risk factors. Results Females experienced revascularization substantially less often than males. All-cause 10-years mortality were higher in females after both CABG 1.15 (1.06–1.25) and PCI 1.17 (1.11–1.23), Males had marginally higher 10-years mortality after CABG compared to PCI (1.04 (1.00-1.10)), while no difference in females (1.03 (0.95–1.13)). Further, males had better survival than the background population, three years after both CABG and PCI, while females after PCI surpassed the population survival after six years but never reached the background population after CABG. Regarding the number of treated vessels/grafts single-PCI had lowest mortality followed by CABG, while 3-vessel PCI had the highest mortality. Conclusion Despite being referred for coronary diagnostication according to their IHD prevalence, females receive revascularization treatment less often and have a substantially higher mortality after revascularization than males. cardiovascular diseases coronary artery disease healthcare disparities ischemic heart disease gender differences coronary arterial bypass grafting percutaneous coronary intervention Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Ischaemic heart disease (IHD) has been the leading cause of death globally for more than three decades accounting for 16% of all deaths in 2019 [ 1 – 3 ]. Chronic cardiovascular disease (CDV) accounts for over 30% of total deaths worldwide [ 3 ]. Despite being a leading cause of death, IHD age-standardised prevalence, incidence, and mortality from IHD have declined globally in both sexes between 1990 and 2019 [ 4–7]. A similar downward trend in IHD-related mortality was observed in Denmark from 1970 to 2015 [ 8 ]. One major factor is the implementation of percutaneous coronary intervention (PCI) as standard treatment for especially acute coronary syndrome (ACS) [ 8 – 9 ], compared to the previous treatment being either coronary artery bypass grafting (CABG) or solely medical treatment. Several studies have shown long-time survival after both CABG and PCI [ 10 – 11 ], but despite significant reduction in postoperative mortality associated with standard cardiac procedures, the role of coronary interventions and surgery in extending life expectancy is a matter of debate [ 12 – 13 ]. Also, despite uniform efforts and contrary to expectations, significant sex based differences in outcomes persist. Females continue to experience higher IHD-related mortality, even though their mortality rates have declined more than that of males over the past three decades [ 4 , 14 – 15 ]. This disparity is believed to be caused by factors such as older age at presentation, a higher degree of atypical symptoms, more comorbidities and risk factors, a greater incidence of procedural complications like bleeding and heart failure, and less frequent treatment with evidence-based therapy such as PCI among females compared to males [ 15 – 19 ]. Furthermore, after PCI females show higher need of target lesion surgical revascularization [ 20 ], suggesting that the result of the interventional procedure may differ from those of males. This study aimed to evaluate mortality and re-intervention free survival after standard CABG or PCI in stable chronic coronary syndrome (CCS) patients, with focus on actual and expected lifetime, based on population data, and impact of age, time, and procedure factors to categorize and map relevant factors in the treatment of IHD. Material and methods Data source The data was obtained from Western Denmark Heart Registry (WDHR), comprising data of all adult patients from the western part of Denmark, undertaking cardiac procedures. Registering in WDHR is mandatory and includes originally invasive coronary angiography (ICA), percutaneous coronary intervention (PCI) and cardiac surgery procedures. In 2007 it was expanded with computed tomography angiography (CTA) and transcatheter aortic valve replacement (TAVR). All procedures are documented with detailed patient-, risk-, procedure-, and care-related data, together with in-hospital complications. The data are collected and registered prospectively and have become integral to clinical practice [ 22 ]. WDHR is known for its high accuracy and completeness, which are justified by validation at data entry, random spot checks, and systematic validation procedures [ 23 ]. All data related to this study have been obligatory since 2006. In earlier registration, the data fields were considered zero or negative, if any other data was registered on the specific formulas. All Danish citizens have a unique civil personal registration number (CPR number) assigned at birth or immigration and kept throughout their entire life, enabling cross-linking between different Danish health and civil registries, ensuring feasibility to conduct large, population-based studies with relevant outcome follow-up on all procedures and medical treatments [ 24 – 25 ]. Study population All patients submitted to PCI (121,775) and isolated CABG (21,478) between 2001 and 2020 were assessed for eligibility. Primary inclusion was the indication of chronic coronary syndrome (CCS), and the exclusion criteria were patients without a valid CPR number and those who had previously undergone cardiac interventions. Only the first procedure was included if the patients underwent multiple PCI and/or CABG procedures. The study data-handling was approved and registered by the Danish Data Protection Agency (1-16-02-455-21). Database study and thus clinical trial number not applicable. According to Danish legislation, written consent is not required for registry-based studies, and all guidelines for the use and handling of data were met. Thus, Human Ethics and Consent to Participate declarations: not applicable. Factors and outcome. The primary outcome was all cause mortality and intervention-free survival after pre-defined periods for up till 20 years. The analysis was based on gender, age, procedure type, comorbidity and the peri-procedural complications of myocardial infarction, stroke, arrhythmias and severe bleeding. The result of interventional coronary angiography (ICA) was obtained from WDHR to evaluate the severity of pre-procedural coronary artery disease, evaluated by investigated number of segments and the coronary stenosis. Considering the long study period with known changes in average living age during the observation period, each patient was assigned an estimated 1- and 5-years risk of death based on the official 5-year life tables from Statistics Denmark (Supplement 1) [ 26 ]. The estimated mortality risk, based on time of the procedure, age, and sex, enabled a 1:1 comparison between the actual study mortality and the expected population mortality. Statistical Analyses The detailed statistical analysis was primarily based on procedure type together with patient age and gender. To avoid too small groups, data was gathered in time groups where appropriate. Categorical variables were primarily analysed using the χ2-test, while in longitudinal analysis was used students-independent t-test or Mann-Whitney independent test depending on data-normality distribution in group or parameter analysis, while ANOVA or Kruskal-Wallis was used for subgroup comparisons. Kaplan-Meier were used to evaluate survival and re-vascularization free survival over time. Logistic regression analyses, with robust error variance to estimate adjusted odds ratios (ORs), were used to identify risk factors with an impact on outcomes, presented as OR with 95% confidence limits (CLs). The included covariates were primarily based on comorbidity factors, indication, period, and sex. All analyses were performed with MedCalc® software version 22.014 (Mariakerke, Belgium). A p-value < 0.05 was considered statistically significant. Results During 2001–2020, a total of 112,985 PCI- and 21,478 isolated CABG-procedures were performed and registered in WDHR, of which respectively 44,624 and 16,504 fulfilled the eligible inclusion criteria of IHD with CCS. Three hundred and eight patients, without a valid CPR number (i.e. refugees or foreigners), 3,795 with a history of previous revascularization before the study start and, 15,154 not first entry procedures during study period, were excluded. After combining the PCI and CABG groups, an additional 1,306 procedures were excluded as not first entry, leaving a cohort of 40,565 procedures for analysis (Fig. 1 ). The number of revascularizations declined gradually over the two decades (Fig. 2 ) from a total of 2,579 in 2002 to 1,445 in 2020 (P < 0.0001; χ2-test). The decrease was statistically significant for both procedures but more pronounced in CABG, declining from 1,177 in 2002 to 407 in 2020. PCI initially had a small increase to 1,606 in 2006, ending at 1,038 in 2020. The female fraction was relatively stable over time, from 23 to 28%, on average 17.9% for CABG and 29.0% for PCI. The age increased marginally during the 2-decades without a difference between procedures. Females were overall 2.4 years (CABG) and 3.4 years (PCI) older than males (Table 1 ). The proportion of patients with diabetes was higher in the CABG group (17.6% vs 14.0%; P < 0.001) as compared to the PCI group and also higher among females than males (19.0% vs. 15.1%; P < 0.001). No difference was observed in kidney function. CABG patients were more often treated with cholesterol-lowering medication, whereas no significant difference was seen in the use of antihypertensive treatment between the groups. Females were more often treated for both hyperlipidaemia and hypertension. Acute procedures are registered as such if unscheduled and done within 24 hours after diagnosing or before next morning program. CABG was more frequently performed as an acute procedure, with the proportion increasing over time, in contrast to PCI, which showed a declining trend. Acute procedures were more common among females (Table 1 ). Table 1 Demographics of patients divided on procedure types and genders. ICA = Invasive coronary angiography; EF = Ejection fraction. Statistics: 2-way ANOVA Factor Procedure Male Female p-value gender Numbers (fraction) CABG 82.1% 17.9% PCI 71.0% 29.0% Age (years) CABG 65,8 68,2 < 0.001 PCI 65,3 68,7 p-value procedure 0.675 Diabetes treatment CABG 17,03 20,30 < 0.001 PCI 13,88 14,18 p-value procedure 200 µmol/L CABG 1,6 1,9 0.495 PCI 1,8 1,2 p-value procedure 0.283 Pre myocardial infarction CABG 32,35 29,79 < 0.001 PCI 15,84 13,00 p-value procedure < 0.001 Treatment lipider statins CABG 67,96 68,19 0.016 PCI 60,86 62,85 p-value procedure < 0.001 Treatment hypertension CABG 55,38 62,50 < 0.001 PCI 54,70 62,35 p-value procedure 0.632 Acute procedure CABG 3,91 4,42 0.056 PCI 1,44 1,67 p-value procedure < 0.001 ICA Segments CABG 3,96 3,72 < 0.001 PCI 2,13 1,95 p-value procedure < 0.001 Average coronary stenosis CABG 80,62 80,23 0.544 PCI 80,94 79,72 p-value procedure 50 CABG 59,89 64,49 < 0.001 PCI 71,98 78,04 Left ventricular EF 30–50 CABG 32,60 28,84 PCI 22,53 17,92 Left ventricular EF < 30 CABG 7,51 6,67 PCI 5,49 5,17 p-value procedure < 0.001 The number of investigated segments were significantly (P < 0.001) higher prior to CABG than PCI (3.9 vs. 2.1) and overall higher in males than in females (2.8 vs 2.4; P < 0.001, 2-way ANOVA). No significant difference in average stenosis severity was observed between procedure types (P = 0.544), although a small but statistically significant difference was found between sexes (80.8% in males vs 79.8% in females; P < 0.001) without clinical relevance. The proportion of patients with one or more registered procedural complications declined during the study period. Complication rates were considerably higher after CABG compared to PCI. Among CABG patients, complication rates decreased from 13.2% in 2001–2005 to 8.8% in 2016–2020 (P < 0.0001) and although lower overall, PCI-related complications also showed a statistically significant reduction from 1.14% to 1.03% (P = 0.008) during the same periods (Table 2 ). After CABG, females more often experienced stroke, myocardial infarction and re-intervention due to ischaemia, while no differences were found in bleeding complications, dialysis and total complications. Regarding PCI, females had a higher overall rate of severe complications, primarily driven by bleeding (Table 2 ). Table 2 Percentages of complications divided on procedures and genders. Severe is combined complications Statistics: χ2-test. Complication CABG PCI Male Female p-value Male Female p-value Cerebral / Stroke 1.24 1.43 < 0.001 0.04 0.09 0.131 Miocardial infarction 4.03 5.54 0.001 0.37 0.46 0.331 Dialysis 1.40 1.63 0.391 0.01 0.01 0.512 Bleeding issue 5.15 4.73 0.371 0.29 0.46 0.026 Redo-Ischaemia 0.83 1.24 0.046 0.19 0.29 0.134 One / more complications 11.15 12.28 0.099 0.82 1.23 0.002 The distribution of treated vessels/grafts (Fig. 3 ) differed significantly between procedures and gender (P < 0.001; 2-way ANOVA). The average number of grafts/treated vessels was significantly lower in PCI than CABG (PCI 1.23 (1.22–1.24) vs CABG 2.52 (2.50–2.53) and significantly higher in males than in females (1.92 (1.91–1.93) vs 1.83 (1.81–1.84). Males showed slightly better 10-years survival than females after both CABG (0.87 (0.80–0.94) and PCI (0.86 (0.81–0.90). Survival seemed better after CABG compared to PCI up till eight years after the primary procedure. Thereafter, PCI showed marginally better survival in males (0.95 (0.91-1.00) but without any difference among females (0.97 (0.89–1.06) (Fig. 4 ). PCI-treated patients had a significantly higher rate of re-interventions with 23.8% for PCI compared to 9.3% for CABG during the first 10 years (P < 0.0001; χ2-test).- Females presented more re-interventions than males after CABG (11.2% vs 8.9%) but fewer after PCI (21,5% vs 24.7%). This is further underlined in Fig. 4 showing significantly lower re-intervention free survival after PCI compared to CABG, and females have better re-intervention free survival than males after PCI, but lower after CABG. Analysing the number of treated vessels/grafts, we saw significantly less re-interventions after CABG than after PCI. In CABG patients, the number of grafts increased the rate of re-interventions (Fig. 4 ). In PCI patients, small reintervention differences existed between the number of treated vessels. Mortality at 30 days, 1- and 5 years declined significantly during the study period, both in relation to procedure type and gender (Table 3 ). The mortality was constantly higher in females. Mortality after CABG was higher versus PCI at 30 days and one year, but higher after PCI at 5 years. Table 3 Mortality divided on periods, procedure types and gender. Statistics 2-Way ANOVA. Periode 2001–2005 2006–2010 2011–2015 2016–2020 p-value procedure Procedure 30-days CABG 2.06% 1.93% 0.87% 0.70% < 0.001 PCI 0.90 0.54 0.56 0.53 p-value period < 0.001 1-year CABG 4.31% 4.49% 2.57% 1.67% 0.164 PCI 3.21% 3.02% 2.96% 2.81% p-value period < 0.001 5-year CABG 14.12% 13.04% 11.45% 9.35% < 0.001 PCI 12.78% 13.76% 14.20% 15.02% p-value period < 0.001 Gender 30-days Male 1.31% 0.97% 0.54% 0.54% < 0.001 Female 1.645 1.10% 1.07% 0.69% p-value period 0.010 1-year Male 3.54% 3.55% 2.65% 2.55% 0.284 Female 4.09% 3.42% 3.30% 2.36% p-value period < 0.001 5-year Male 13.02% 13.72% 12.39% 12.56% < 0.001 Female 12.52% 13.89% 13.60% 14.15% p-value period < 0.001 Logistic regression analyses (Table 4 ) revealed that age, diabetes, s-Creatinine above 200 µmol/L, previous myocardial infarction and poor left ventricular function had a negative impact on mortality at all measurement times. Female sex and re-intervention had a negative effect on short term outcomes, while acute procedure had negative influence up to 5 years after the index procedure. Hyperlipidaemic treatment constantly had a positive effect. PCI had positive impact on short term and a negative impact at 5 years with no effect after one and 10 years. Table 4 Adjusted odds-ration (95% confidence limits) of factors with possible impact on mortality. EF = ejection fraction. Factor 30 days mortality 1-year mortality 5-years mortality 10-years mortality Age (EuroSCORE groups) 1.52 (1.40–1.64) 1.49 (1.43–1.56) 1.54 (1.49–1.56) 1.54 (1.52–1.57) Female sex 1.41 (1.05–1.88) 0.98 (0.83–1.16) 0.98 (0.89–1.07) 1.03 (0.96–1.11) Diabetes treatment 1.44 (1.05–1.97) 1.46 (1.22–1.73) 1.56 (1.42–1.71) 1.70 (1.58–1.84) s-Creatinine ≥ 200Umol/L 3.19 (2.43–6.31) 4.88 (3.71–6.40) 6.52 (5.35–7.95) 7.08 (5.76–8.70) Cholesterol lowering statins 0.69 (0.52–0.92) 0.77 (0.66–0.90) 0.85 (0.78–0.93) 0.90 (0.84–0.96) Treatment hypertension 1.05 (0.79–1.40) 1.03 (0.88–1.20) 1.07 (0.98–1.17) 1.08 (1.01–1.16) Pre- myocardial infarction 1.83 (1.38–2.44) 1.21 (1.02–1.44) 1.18 (1.07–1.30) 1.55 (1.33–1.56) Left ventricular EF 30–50 1.87 (1.38–2.53) 1.79 (1.52–2.11) 1.91 (1.75–2.08) 1.93 (1.80–2.07) Left ventricular EF > 30 4.06 (2.81–5.86) 4.27 (3.47–5.25) 3.79 (3.33–4.32) 3.67 (3.26–4.12) Acute procedure 3.46 (2.25–5.33) 2.30 (1.65–3.20) 1.36 (1.07–1.74) 0.99 (0.80–1.22) Re-intervention in period 3.11 (1.90–5.08) 1.11 (0.86–1.43) 0.90 (0.80–1.01) 0.94 (0.86–1.02) PCI procedure 0.36 (0.27–0.49) 0.88 (0.75–1.03) 1.12 (1.03–1.22) 0.97 (0.92–1.04) Comparing the actual 10-year survival with the calculated background population reveals considerable differences between genders. Females had a significant lower survival than males after both CABG (1.15 (1.06–1.25) and PCI (1.21 (1.11–1.31). Males had better survival than the background population around three years after both CABG and PCI, while PCI-treated females surpassed the population survival after six years but never after CABG (Fig. 5 ). Discussion We analysed perioperative data from 40,565 first-time revascularizations performed for CCS between 2001 and 2020, focusing on survival in relation to procedure type, sex, and the general population. Females had poorer survival than males at all points of time, regardless of whether they underwent CABG or PCI. Notably, males had better survival than the background population after both CABG and PCI around three years after the intervention, while females who underwent PCI only exceeded population survival after six years and never reached the survival levels seen after CABG. There was a steady 40% decline in repeat revascularization procedures over the study period, primarily driven by a 64% reduction in CABG, compared to a 21% decrease in PCI. PCI was followed by substantially more re-interventions than CABG, and females experienced more re-interventions after both procedures than males. Overall, we found no consistent difference in mortality between PCI and CABG, but single-vessel PCI showed significantly lower 10-year mortality. CABG was associated with higher re-intervention-free survival. Postoperative complications such as stroke, renal failure, myocardial infarction, bleeding, and need of transfusion were more common in females, possibly reflecting more severe preoperative comorbidities, such as impaired renal or pulmonary function, extensive atherosclerosis, or poor ventricular function. Also, females were older, had more diabetes, and more often presented acutely, but had less prior myocardial infarction, better ejection fraction, and more frequent treated hyperlipidaemia. The number of stenotic coronary segments before revascularization was slightly lower in females (3.7 vs. 4.0), as was the degree of stenosis. The number of treated vessels was also lower in females (2.5 vs. 2.6 for CABG; 1.2 vs. 1.3 for PCI), probably reflecting suboptimal revascularization. Despite all patients being first-time stable CCS cases, our mortality findings after cardiac surgery are consistent with previous studies [ 25 , 27 – 28 ]. Yet, a central unresolved issue is the paradox that, while males have a marginally higher IHD prevalence, they consistently show lower mortality—even though females undergo fewer revascularizations. This supports existing evidence that cardiovascular disease is often diagnosed later in females, possibly due to their more atypical symptom presentation [ 29 , 30 ], leading to delays in investigation and treatment. In Denmark, males account for 61% of IHD patients [ 26 , 31 ], closely matching their 59.2% representation among 219,377 first-time entries in the Western Denmark Heart Registry undergoing CTA or ICA. Females comprise 40.8% of these diagnostic procedures but only 25% of revascularizations, a gap not readily explained. Interestingly, females contribute 43.9% of referrals from primary care slightly above their IHD prevalence suggesting equitable referral practices in the primary sector. Therefore, underrepresentation of females in revascularization is likely a sorting out after the diagnostic stage. Only 11.4% of the 89,414 females undergoing CTA/ICA proceeded to revascularization, compared to 23.4% of 129,963 males more than double, ultimately resulting in only one in four undergoing revascularizations being female. Although females had slightly fewer coronary arteries investigated and a marginally lower degree of stenosis, these differences are unlikely to explain the disparity in revascularization rates. Their mixed comorbidity profile—with fewer previous MIs and better LV function, but more diabetes, older age, and acute presentations—shows no consistent pattern or bias to explain referral decisions post-ICA. Across all time points, mortality remained higher in females than males, and males even outperformed the background population after both CABG and PCI. Despite some improvement in female outcomes over the past two decades [ 8 ], overall mortality remains higher in females, with an excess of 7.8 deaths per 1,000 compared to 3.9 in males [ 31 ]. While absolute IHD mortality rates are higher in male, particularly at younger ages, risk-adjusted mortality is often higher in females - suggesting fewer females develop IHD, but when they do, they face a higher risk of dying from it [ 32 ]. This is also reflected in the slightly higher complication rates and co-morbidities among females. As expected, the number of treated vessels significantly differed across procedures: CABG typically involved multiple grafts, while PCI was more often single-vessel procedures. Although overall survival appeared higher after PCI, stratification by number of treated vessels revealed that multi-vessel PCI had the poorest survival and the highest rate of re-intervention. Our findings thus support that CABG and PCI are viable treatment options. Still, CABG may offer superior long-term outcomes, particularly regarding survival and reduced need for re-intervention [ 33 ]. Strengths and limitations A key asset of this study is its large, representative cohort from WDHR, which enhances the generalizability and reliability of the findings. The primary strengths are mandatory and obligatory prospectively reported data from a well-established uptake area and a common database used by all institutions. The large cohort with detailed and complete follow-up data on all patients undergoing CABG and PCI over 2 decades allows robust estimations of patients, results, and adverse events. Nevertheless, our study has intrinsic limitations, as we cannot discard its non-randomized nature and that the additional effects of missing covariates and the lack of randomization, potentially increase the risk of confounding. Thus, the observational and retrospective nature of the data introduces potential biases and confounding factors. The uniform treatment practices in Denmark with a vell organised and public funded health system reduce variability but perhaps limits country generalisation. The long study period poses challenges from possible changes in clinical procedures. Additionally, including the study population in the background population mortality data may minimally skew comparisons, though exclusion was not feasible in the current study. Conclusion Despite being referred for coronary diagnostication according to their IHD prevalence, females receive revascularization treatment less often and have a substantially higher mortality after revascularization than males, which becomes especially evident when correlating with the mortality of the background population. In multivessel treatments, CABG might often the best alternative. Abbreviations ACS Acute coronary syndrome CABG Coronary arterial bypass grafting CCS Chronic coronary syndrome CTA Computed tomography angiography CPR Civil personal registration CVD Cardiovascular disease ICA Invasive coronary angiography ICD-10 International classification of diseases, 10th revision ICU Intensive care unit IHD Ischaemic heart disease PCI Percutaneous coronary intervention TAVR Transcatheter aortic valve replacement WDHR Western Denmark Heart Registry Declarations Ethics approval and consent to participate: Database study registered by the Danish Data Protection Agency (1-16-02-455-21). According to Danish legislation, consent is not required for registry-based studies. Consent for publication : All authors consent for publication in the BMI journal Availability of data and materials: The datasets generated for use in the current study are not publicly available as part of the Danish patient/hospital system, but limited blinded data are available from the corresponding author on reasonable request and subsequent permissions from hospital/database managers. Competing Interests: The authors have no competing interest Funding: Except support from authors clinics, no external funding. Disclosures : The authors have nothing to disclose. Authors' contributions : Jakobsen and Bhavsar study design; Jakobsen data acquisition and analysis; Bhavsar, Jakobsen, Tang, Kjaergaard-Andersen and Thuesen writing and critical review. Acknowledgement: We acknowledge the help of the English language expert form the South Denmark university and the assistance in refining the language of the manuscript. References World Health Organization. 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Rasmussen LA, Botker HE, Jensen LO, Ravkilde J, Riber L, Nielsen PH et al. Quality assurance of the Western Denmark Heart Registry, a population-based healthcare register. Dan Med J 2017; 64. Pedersen CB. The Danish Civil Registration System. Scand J Public Health. 2011;39:22–5. Bhavsar RTM, Nielsen PH, Jakobsen CJ. Standard CABG - Pain killers or extending life? Austin J Surg 2023; 10. Statstics Denmark. Life Expectancy & Deaths. 2023 [Available from: https://www.dst.dk/en/Statistik/emner/borgere/befolkning/doedsfald Dalen M, Nielsen S, Ivert T, Holzmann MJ, Sartipy U. Coronary artery bypass grafting in women 50 years or younger. J Am Heart Assoc. 2019;8:e013211. 10.1161/JAHA.119.013211 . Dixon LK, Dimagli A, Di Tommaso E, Sinha S, Fudulu DP, Sandhu M, et al. Females have an increased risk of short-term mortality after cardiac surgery compared to males: Insights from a national database. J Card Surg. 2022;37:3507–19. 10.1111/jocs.16928 . Haider A, Bengs S, Luu J, Osto E, Siller-Matula JM, Muka T, et al. Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome. Eur Heart J. 2020;41:1328–36. 10.1093/eurheartj/ehz898 . Parvand M, Rayner-Hartley E, Sedlak T. Recent developments in sex-related differences in presentation, prognosis, and management of coronary artery disease. Can J Cardiol. 2018;34:390–9. Mairy I, Rosenkilde S, Klitgaard MB, Thygesen LC. Sygdomsbyrden i Danmark - sygdomme., København. Sundhedsstyrelsen; 2022. National Institute of National Health, University of Southern Denmark; 2022; 288–290. https://www.ft.dk/samling/20222/almdel/suu/bilag/107/2670755.pdf Romeo B, Bergami M, Cenko E, Manfrini O, Bugiardini R. Sex disparities in ischemic heart disease mortality in Europe. JACC: Adv. 2024;3:101252. doi.org/10.1016/j.jacadv.2024.101252 . Spadaccio C, Benedetto U. Coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in the treatment of multivessel coronary disease: quo vadis? - a review of the evidences on coronary artery disease. Ann Cardiothorac Surg. 2018;7:506–15. 10.21037/acs.2018.05.17 . Additional Declarations No competing interests reported. Supplementary Files Supp1.pdf Supplement 1 . Population background survival divided into 5-year periods and by gender. Survival curves based on one year mortality of the actual ages (15-99 years; Data from Danish Statistics). href="https://www.dst.dk/en/">https://www.dst.dk/en/ GrafphicPicture.pdf Cite Share Download PDF Status: Published Journal Publication published 25 Mar, 2026 Read the published version in BMC Cardiovascular Disorders → Version 1 posted Editorial decision: Revision requested 07 Oct, 2025 Reviews received at journal 04 Oct, 2025 Reviews received at journal 04 Oct, 2025 Reviewers agreed at journal 29 Sep, 2025 Reviewers agreed at journal 28 Sep, 2025 Reviewers invited by journal 27 Sep, 2025 Editor assigned by journal 22 Sep, 2025 Submission checks completed at journal 22 Sep, 2025 First submitted to journal 19 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7657148","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":526258432,"identity":"84a5798c-7578-41e0-abc3-e308faf7c080","order_by":0,"name":"Rajesh Bhavsar","email":"","orcid":"","institution":"South Jutland Hospital, University of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Rajesh","middleName":"","lastName":"Bhavsar","suffix":""},{"id":526258434,"identity":"c6917c87-3add-4f4b-99ff-dd18c5dde324","order_by":1,"name":"Mariann Tang","email":"","orcid":"","institution":"Aalborg University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mariann","middleName":"","lastName":"Tang","suffix":""},{"id":526258435,"identity":"181bc8fd-21c3-4073-a9da-1d21ecd69991","order_by":2,"name":"Leif Thuesen","email":"","orcid":"","institution":"Aalborg University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Leif","middleName":"","lastName":"Thuesen","suffix":""},{"id":526258437,"identity":"5d4a4434-8197-47ed-8e42-3d049a649cdb","order_by":3,"name":"Gundhild Kjaergaard-Andersen","email":"","orcid":"","institution":"South Jutland Hospital, University of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Gundhild","middleName":"","lastName":"Kjaergaard-Andersen","suffix":""},{"id":526258438,"identity":"dad5b2b2-6e0f-46eb-81f3-6a185dfcb5c5","order_by":4,"name":"Carl-Johan 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15:10:26","extension":"pdf","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":116061,"visible":true,"origin":"","legend":"","description":"","filename":"Supp1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7657148/v1/e196588908a7fd893794128a.pdf"},{"id":93245691,"identity":"216acd7a-be3d-4cae-bc34-84f59df79b1b","added_by":"auto","created_at":"2025-10-10 15:10:26","extension":"pdf","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":44367,"visible":true,"origin":"","legend":"","description":"","filename":"figure1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7657148/v1/67b5609a15b8abd0fa205896.pdf"},{"id":93245698,"identity":"d44afe80-2fba-4b70-830a-091f7ec7389c","added_by":"auto","created_at":"2025-10-10 15:10:26","extension":"xml","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":115962,"visible":true,"origin":"","legend":"","description":"","filename":"aa67da8d07494c7396f4c95d745c01901structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7657148/v1/1b41eef6fc595deed59c18a5.xml"},{"id":93245696,"identity":"f271e2a2-c083-49b9-844d-3c075d72153e","added_by":"auto","created_at":"2025-10-10 15:10:26","extension":"html","order_by":22,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":126703,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7657148/v1/c16d1039e593229df876f16e.html"},{"id":93245676,"identity":"b54cf099-bb5b-4779-b60d-cc46ffa914f7","added_by":"auto","created_at":"2025-10-10 15:10:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":52835,"visible":true,"origin":"","legend":"\u003cp\u003eEligible patients and exclusions divided by procedure types.\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7657148/v1/3b0246103b2f6a7523150296.png"},{"id":93245677,"identity":"c361cdd5-97d5-4c47-a68a-85906e903422","added_by":"auto","created_at":"2025-10-10 15:10:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":29763,"visible":true,"origin":"","legend":"\u003cp\u003eThe number of revascularization procedures 2001-2020 divided by type and gender, and the overall female fraction (red line). Overall, significant decline in CABG and PCI (P\u0026lt;0.0001; χ2-test). Females showed significant lower numbers throughout the period (P\u0026gt;0.0001; χ2-test), with totally 25.0% and 17.9 % in CABG and 29.0% in PCI.\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7657148/v1/779e0bb4d0d6e589d6f33c6e.png"},{"id":93245682,"identity":"9b8eaf75-647d-438c-ae86-9a5facf7e105","added_by":"auto","created_at":"2025-10-10 15:10:26","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":10951,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of treated vessels / grafts divided on procedure type and gender. Distribution of treated vessels / grafts was significant different both in procedure types and genders. (P\u0026lt;0.001; 2-way ANOVA).\u003c/p\u003e","description":"","filename":"figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7657148/v1/9bc145d88e255ed54c64946d.png"},{"id":93245695,"identity":"a2e9f6d0-9e97-459a-947c-bdf5f24f242e","added_by":"auto","created_at":"2025-10-10 15:10:26","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":237510,"visible":true,"origin":"","legend":"\u003cp\u003e10-years survival and revascularization-free survival divided \u0026nbsp;by procedure type and gender (left panels) and procedure type and treated vessels/grafts (right panels). Hazard ratios showed better survival in males than females after both CABG (0.87 (0.80-0.94) and PCI (0.90 (0.84-0.95). Male survival was marginally higher after PCI compared to CABG (0.95 (0.91-1.00), while no difference in females (0.97 (0.89-1.06)). Females had higher revascularization-free survival after PCI (0.86 (0.81-0.91), while males \u0026nbsp;had higher after CABG (0.79 (0.72-0.87). Revascularization free survival was overall higher in CABG compared to PCI (males 0.32 (0.30-0.34), females 0.47 (0.43-0.52)). Regarding treated coronaries highest survival rates was after one-vessel PCI, while 2 or 3-vessels PCI was lowest and CABG in between (P\u0026lt;0.0001). Re-intervention free survival was substantially better after CABG compared to PCI (closest CABG 1 vs PCI 3 (0.64 (0.52-0.80). No statistically significant difference between PCI groups, while significant differences between CABG groups.\u003c/p\u003e","description":"","filename":"figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7657148/v1/ca70c78482e954b6001bd44c.png"},{"id":93245680,"identity":"59523236-ba52-4089-8b39-00d2a95bfe0b","added_by":"auto","created_at":"2025-10-10 15:10:26","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":46262,"visible":true,"origin":"","legend":"\u003cp\u003eActual and calculated population 10-years survival of all first entry revascularizations, based on procedure type (upper panels) and gender (lower panels). Overall, males had better survival than females in the population after 3-4 years after both CABG and PCI. Females submitted to PCI surpassed the population after 6 years but never captured the population after CABG.\u003c/p\u003e","description":"","filename":"figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-7657148/v1/e42b0353d229b241799aaa00.png"},{"id":105755138,"identity":"3feef158-c5df-46c9-ae61-6f9c466f86c5","added_by":"auto","created_at":"2026-03-30 16:25:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1323923,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7657148/v1/b4dda3d0-328e-483b-8e20-e03678415f30.pdf"},{"id":93245678,"identity":"edfe40f0-f33a-4a27-9aee-f0565dc07370","added_by":"auto","created_at":"2025-10-10 15:10:26","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":116061,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eSupplement 1\u003c/em\u003e. Population background survival divided into 5-year periods and by gender. Survival curves based on one year mortality of the actual ages (15-99 years; Data from Danish Statistics). \u003ca href=\"https://www.dst.dk/en/\"\u003ehttps://www.dst.dk/en/\u003c/a\u003e\u003c/p\u003e","description":"","filename":"Supp1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7657148/v1/24f7032ce0ffa0928bcc70f7.pdf"},{"id":93246708,"identity":"6bea298d-1fa9-4cb5-80a8-551e6deba30d","added_by":"auto","created_at":"2025-10-10 15:18:26","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":22749,"visible":true,"origin":"","legend":"","description":"","filename":"GrafphicPicture.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7657148/v1/4d64dd5b6e5506138a330246.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sex disparities in coronary re-vascularisation and mortality","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIschaemic heart disease (IHD) has been the leading cause of death globally for more than three decades accounting for 16% of all deaths in 2019 [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Chronic cardiovascular disease (CDV) accounts for over 30% of total deaths worldwide [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite being a leading cause of death, IHD age-standardised prevalence, incidence, and mortality from IHD have declined globally in both sexes between 1990 and 2019 [ 4\u0026ndash;7]. A similar downward trend in IHD-related mortality was observed in Denmark from 1970 to 2015 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. One major factor is the implementation of percutaneous coronary intervention (PCI) as standard treatment for especially acute coronary syndrome (ACS) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], compared to the previous treatment being either coronary artery bypass grafting (CABG) or solely medical treatment.\u003c/p\u003e\u003cp\u003eSeveral studies have shown long-time survival after both CABG and PCI [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], but despite significant reduction in postoperative mortality associated with standard cardiac procedures, the role of coronary interventions and surgery in extending life expectancy is a matter of debate [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Also, despite uniform efforts and contrary to expectations, significant sex based differences in outcomes persist. Females continue to experience higher IHD-related mortality, even though their mortality rates have declined more than that of males over the past three decades [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This disparity is believed to be caused by factors such as older age at presentation, a higher degree of atypical symptoms, more comorbidities and risk factors, a greater incidence of procedural complications like bleeding and heart failure, and less frequent treatment with evidence-based therapy such as PCI among females compared to males [\u003cspan additionalcitationids=\"CR16 CR17 CR18\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Furthermore, after PCI females show higher need of target lesion surgical revascularization [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], suggesting that the result of the interventional procedure may differ from those of males.\u003c/p\u003e\u003cp\u003eThis study aimed to evaluate mortality and re-intervention free survival after standard CABG or PCI in stable chronic coronary syndrome (CCS) patients, with focus on actual and expected lifetime, based on population data, and impact of age, time, and procedure factors to categorize and map relevant factors in the treatment of IHD.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData source\u003c/h2\u003e\u003cp\u003eThe data was obtained from Western Denmark Heart Registry (WDHR), comprising data of all adult patients from the western part of Denmark, undertaking cardiac procedures. Registering in WDHR is mandatory and includes originally invasive coronary angiography (ICA), percutaneous coronary intervention (PCI) and cardiac surgery procedures. In 2007 it was expanded with computed tomography angiography (CTA) and transcatheter aortic valve replacement (TAVR). All procedures are documented with detailed patient-, risk-, procedure-, and care-related data, together with in-hospital complications. The data are collected and registered prospectively and have become integral to clinical practice [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. WDHR is known for its high accuracy and completeness, which are justified by validation at data entry, random spot checks, and systematic validation procedures [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. All data related to this study have been obligatory since 2006. In earlier registration, the data fields were considered zero or negative, if any other data was registered on the specific formulas.\u003c/p\u003e\u003cp\u003eAll Danish citizens have a unique civil personal registration number (CPR number) assigned at birth or immigration and kept throughout their entire life, enabling cross-linking between different Danish health and civil registries, ensuring feasibility to conduct large, population-based studies with relevant outcome follow-up on all procedures and medical treatments [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eAll patients submitted to PCI (121,775) and isolated CABG (21,478) between 2001 and 2020 were assessed for eligibility. Primary inclusion was the indication of chronic coronary syndrome (CCS), and the exclusion criteria were patients without a valid CPR number and those who had previously undergone cardiac interventions. Only the first procedure was included if the patients underwent multiple PCI and/or CABG procedures.\u003c/p\u003e\u003cp\u003eThe study data-handling was approved and registered by the Danish Data Protection Agency (1-16-02-455-21). Database study and thus clinical trial number not applicable. According to Danish legislation, written consent is not required for registry-based studies, and all guidelines for the use and handling of data were met. Thus, Human Ethics and Consent to Participate declarations: not applicable.\u003c/p\u003e\u003cp\u003e\u003cem\u003eFactors and outcome.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe primary outcome was all cause mortality and intervention-free survival after pre-defined periods for up till 20 years.\u003c/p\u003e\u003cp\u003eThe analysis was based on gender, age, procedure type, comorbidity and the peri-procedural complications of myocardial infarction, stroke, arrhythmias and severe bleeding. The result of interventional coronary angiography (ICA) was obtained from WDHR to evaluate the severity of pre-procedural coronary artery disease, evaluated by investigated number of segments and the coronary stenosis.\u003c/p\u003e\u003cp\u003eConsidering the long study period with known changes in average living age during the observation period, each patient was assigned an estimated 1- and 5-years risk of death based on the official 5-year life tables from Statistics Denmark (Supplement 1) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The estimated mortality risk, based on time of the procedure, age, and sex, enabled a 1:1 comparison between the actual study mortality and the expected population mortality.\u003c/p\u003e\n\u003ch3\u003eStatistical Analyses\u003c/h3\u003e\n\u003cp\u003eThe detailed statistical analysis was primarily based on procedure type together with patient age and gender. To avoid too small groups, data was gathered in time groups where appropriate. Categorical variables were primarily analysed using the χ2-test, while in longitudinal analysis was used students-independent t-test or Mann-Whitney independent test depending on data-normality distribution in group or parameter analysis, while ANOVA or Kruskal-Wallis was used for subgroup comparisons.\u003c/p\u003e\u003cp\u003eKaplan-Meier were used to evaluate survival and re-vascularization free survival over time. Logistic regression analyses, with robust error variance to estimate adjusted odds ratios (ORs), were used to identify risk factors with an impact on outcomes, presented as OR with 95% confidence limits (CLs). The included covariates were primarily based on comorbidity factors, indication, period, and sex. All analyses were performed with MedCalc\u0026reg; software version 22.014 (Mariakerke, Belgium). A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring 2001\u0026ndash;2020, a total of 112,985 PCI- and 21,478 isolated CABG-procedures were performed and registered in WDHR, of which respectively 44,624 and 16,504 fulfilled the eligible inclusion criteria of IHD with CCS. Three hundred and eight patients, without a valid CPR number (i.e. refugees or foreigners), 3,795 with a history of previous revascularization before the study start and, 15,154 not first entry procedures during study period, were excluded. After combining the PCI and CABG groups, an additional 1,306 procedures were excluded as not first entry, leaving a cohort of 40,565 procedures for analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe number of revascularizations declined gradually over the two decades (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) from a total of 2,579 in 2002 to 1,445 in 2020 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001; χ2-test). The decrease was statistically significant for both procedures but more pronounced in CABG, declining from 1,177 in 2002 to 407 in 2020. PCI initially had a small increase to 1,606 in 2006, ending at 1,038 in 2020. The female fraction was relatively stable over time, from 23 to 28%, on average 17.9% for CABG and 29.0% for PCI.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe age increased marginally during the 2-decades without a difference between procedures. Females were overall 2.4 years (CABG) and 3.4 years (PCI) older than males (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The proportion of patients with diabetes was higher in the CABG group (17.6% vs 14.0%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as compared to the PCI group and also higher among females than males (19.0% vs. 15.1%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No difference was observed in kidney function. CABG patients were more often treated with cholesterol-lowering medication, whereas no significant difference was seen in the use of antihypertensive treatment between the groups. Females were more often treated for both hyperlipidaemia and hypertension. Acute procedures are registered as such if unscheduled and done within 24 hours after diagnosing or before next morning program. CABG was more frequently performed as an acute procedure, with the proportion increasing over time, in contrast to PCI, which showed a declining trend. Acute procedures were more common among females (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographics of patients divided on procedure types and genders. ICA\u0026thinsp;=\u0026thinsp;Invasive coronary angiography; EF\u0026thinsp;=\u0026thinsp;Ejection fraction. Statistics: 2-way ANOVA\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProcedure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003ep-value gender\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNumbers (fraction)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82.1%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.9%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71.0%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29.0%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65,8\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68,2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65,3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68,7\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value procedure\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.675\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDiabetes treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17,03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20,30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13,88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14,18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value procedure\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eS-creatinine\u0026thinsp;\u0026gt;\u0026thinsp;200 \u0026micro;mol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e0.495\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value procedure\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.283\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre myocardial infarction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32,35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29,79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15,84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13,00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value procedure\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTreatment lipider statins\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67,96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68,19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e0.016\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60,86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62,85\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value procedure\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTreatment hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55,38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62,50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54,70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62,35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value procedure\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.632\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAcute procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3,91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e0.056\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value procedure\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eICA Segments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3,96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value procedure\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAverage coronary stenosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80,62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80,23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e0.544\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80,94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79,72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value procedure\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft ventricular EF\u0026thinsp;\u0026gt;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59,89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64,49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71,98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78,04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft ventricular EF 30\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32,60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28,84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22,53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17,92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft ventricular EF\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7,51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6,67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5,49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value procedure\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe number of investigated segments were significantly (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) higher prior to CABG than PCI (3.9 vs. 2.1) and overall higher in males than in females (2.8 vs 2.4; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 2-way ANOVA). No significant difference in average stenosis severity was observed between procedure types (P\u0026thinsp;=\u0026thinsp;0.544), although a small but statistically significant difference was found between sexes (80.8% in males vs 79.8% in females; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) without clinical relevance.\u003c/p\u003e\u003cp\u003eThe proportion of patients with one or more registered procedural complications declined during the study period. Complication rates were considerably higher after CABG compared to PCI. Among CABG patients, complication rates decreased from 13.2% in 2001\u0026ndash;2005 to 8.8% in 2016\u0026ndash;2020 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and although lower overall, PCI-related complications also showed a statistically significant reduction from 1.14% to 1.03% (P\u0026thinsp;=\u0026thinsp;0.008) during the same periods (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). After CABG, females more often experienced stroke, myocardial infarction and re-intervention due to ischaemia, while no differences were found in bleeding complications, dialysis and total complications. Regarding PCI, females had a higher overall rate of severe complications, primarily driven by bleeding (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePercentages of complications divided on procedures and genders. Severe is combined complications Statistics: χ2-test.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplication\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCABG\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePCI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCerebral / Stroke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.131\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiocardial infarction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.331\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDialysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.391\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.512\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBleeding issue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.371\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.026\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRedo-Ischaemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.046\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.134\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOne / more complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e0.099\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e0.002\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe distribution of treated vessels/grafts (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) differed significantly between procedures and gender (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; 2-way ANOVA). The average number of grafts/treated vessels was significantly lower in PCI than CABG (PCI 1.23 (1.22\u0026ndash;1.24) vs CABG 2.52 (2.50\u0026ndash;2.53) and significantly higher in males than in females (1.92 (1.91\u0026ndash;1.93) vs 1.83 (1.81\u0026ndash;1.84).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eMales showed slightly better 10-years survival than females after both CABG (0.87 (0.80\u0026ndash;0.94) and PCI (0.86 (0.81\u0026ndash;0.90). Survival seemed better after CABG compared to PCI up till eight years after the primary procedure. Thereafter, PCI showed marginally better survival in males (0.95 (0.91-1.00) but without any difference among females (0.97 (0.89\u0026ndash;1.06) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003ePCI-treated patients had a significantly higher rate of re-interventions with 23.8% for PCI compared to 9.3% for CABG during the first 10 years (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001; χ2-test).- Females presented more re-interventions than males after CABG (11.2% vs 8.9%) but fewer after PCI (21,5% vs 24.7%). This is further underlined in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e showing significantly lower re-intervention free survival after PCI compared to CABG, and females have better re-intervention free survival than males after PCI, but lower after CABG.\u003c/p\u003e\u003cp\u003eAnalysing the number of treated vessels/grafts, we saw significantly less re-interventions after CABG than after PCI. In CABG patients, the number of grafts increased the rate of re-interventions (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In PCI patients, small reintervention differences existed between the number of treated vessels.\u003c/p\u003e\u003cp\u003eMortality at 30 days, 1- and 5 years declined significantly during the study period, both in relation to procedure type and gender (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The mortality was constantly higher in females. Mortality after CABG was higher versus PCI at 30 days and one year, but higher after PCI at 5 years.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMortality divided on periods, procedure types and gender. Statistics 2-Way ANOVA.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePeriode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2001\u0026ndash;2005\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2006\u0026ndash;2010\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2011\u0026ndash;2015\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2016\u0026ndash;2020\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep-value procedure\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProcedure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e30-days\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eCABG\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.06%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.93%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.87%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.70%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePCI\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value period\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e1-year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eCABG\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.31%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.49%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.57%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.67%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e0.164\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePCI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.21%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.02%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.96%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.81%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value period\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e5-year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eCABG\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.12%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.04%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.45%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.35%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePCI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.78%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.76%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.20%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.02%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value period\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e30-days\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.31%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.97%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.54%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.54%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.645\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.10%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.07%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.69%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value period\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003e0.010\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e1-year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.54%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.55%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.65%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.55%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e0.284\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.09%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.42%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.30%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.36%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value period\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e5-year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.02%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.72%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.39%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12.56%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.52%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.89%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.60%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.15%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ep-value period\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\u0026lt;\u0026thinsp;0.001\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLogistic regression analyses (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) revealed that age, diabetes, s-Creatinine above 200 \u0026micro;mol/L, previous myocardial infarction and poor left ventricular function had a negative impact on mortality at all measurement times. Female sex and re-intervention had a negative effect on short term outcomes, while acute procedure had negative influence up to 5 years after the index procedure. Hyperlipidaemic treatment constantly had a positive effect. PCI had positive impact on short term and a negative impact at 5 years with no effect after one and 10 years.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAdjusted odds-ration (95% confidence limits) of factors with possible impact on mortality. EF\u0026thinsp;=\u0026thinsp;ejection fraction.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 days mortality\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1-year mortality\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5-years mortality\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10-years mortality\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (EuroSCORE groups)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.52 (1.40\u0026ndash;1.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.49 (1.43\u0026ndash;1.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.54 (1.49\u0026ndash;1.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.54 (1.52\u0026ndash;1.57)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale sex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.41 (1.05\u0026ndash;1.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.98 (0.83\u0026ndash;1.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.98 (0.89\u0026ndash;1.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.03 (0.96\u0026ndash;1.11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.44 (1.05\u0026ndash;1.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.46 (1.22\u0026ndash;1.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.56 (1.42\u0026ndash;1.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.70 (1.58\u0026ndash;1.84)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003es-Creatinine\u0026thinsp;\u0026ge;\u0026thinsp;200Umol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.19 (2.43\u0026ndash;6.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.88 (3.71\u0026ndash;6.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.52 (5.35\u0026ndash;7.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.08 (5.76\u0026ndash;8.70)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCholesterol lowering statins\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.69 (0.52\u0026ndash;0.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.77 (0.66\u0026ndash;0.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.85 (0.78\u0026ndash;0.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.90 (0.84\u0026ndash;0.96)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTreatment hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.05 (0.79\u0026ndash;1.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.03 (0.88\u0026ndash;1.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.07 (0.98\u0026ndash;1.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.08 (1.01\u0026ndash;1.16)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre- myocardial infarction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.83 (1.38\u0026ndash;2.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.21 (1.02\u0026ndash;1.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.18 (1.07\u0026ndash;1.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.55 (1.33\u0026ndash;1.56)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft ventricular EF 30\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.87 (1.38\u0026ndash;2.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.79 (1.52\u0026ndash;2.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.91 (1.75\u0026ndash;2.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.93 (1.80\u0026ndash;2.07)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft ventricular EF\u0026thinsp;\u0026gt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.06 (2.81\u0026ndash;5.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.27 (3.47\u0026ndash;5.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.79 (3.33\u0026ndash;4.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.67 (3.26\u0026ndash;4.12)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcute procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.46 (2.25\u0026ndash;5.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.30 (1.65\u0026ndash;3.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.36 (1.07\u0026ndash;1.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.99 (0.80\u0026ndash;1.22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRe-intervention in period\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.11 (1.90\u0026ndash;5.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.11 (0.86\u0026ndash;1.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.90 (0.80\u0026ndash;1.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.94 (0.86\u0026ndash;1.02)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCI procedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.36 (0.27\u0026ndash;0.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.88 (0.75\u0026ndash;1.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.12 (1.03\u0026ndash;1.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.97 (0.92\u0026ndash;1.04)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eComparing the actual 10-year survival with the calculated background population reveals considerable differences between genders. Females had a significant lower survival than males after both CABG (1.15 (1.06\u0026ndash;1.25) and PCI (1.21 (1.11\u0026ndash;1.31). Males had better survival than the background population around three years after both CABG and PCI, while PCI-treated females surpassed the population survival after six years but never after CABG (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe analysed perioperative data from 40,565 first-time revascularizations performed for CCS between 2001 and 2020, focusing on survival in relation to procedure type, sex, and the general population. Females had poorer survival than males at all points of time, regardless of whether they underwent CABG or PCI. Notably, males had better survival than the background population after both CABG and PCI around three years after the intervention, while females who underwent PCI only exceeded population survival after six years and never reached the survival levels seen after CABG. There was a steady 40% decline in repeat revascularization procedures over the study period, primarily driven by a 64% reduction in CABG, compared to a 21% decrease in PCI. PCI was followed by substantially more re-interventions than CABG, and females experienced more re-interventions after both procedures than males.\u003c/p\u003e\u003cp\u003eOverall, we found no consistent difference in mortality between PCI and CABG, but single-vessel PCI showed significantly lower 10-year mortality. CABG was associated with higher re-intervention-free survival. Postoperative complications such as stroke, renal failure, myocardial infarction, bleeding, and need of transfusion were more common in females, possibly reflecting more severe preoperative comorbidities, such as impaired renal or pulmonary function, extensive atherosclerosis, or poor ventricular function. Also, females were older, had more diabetes, and more often presented acutely, but had less prior myocardial infarction, better ejection fraction, and more frequent treated hyperlipidaemia.\u003c/p\u003e\u003cp\u003eThe number of stenotic coronary segments before revascularization was slightly lower in females (3.7 vs. 4.0), as was the degree of stenosis. The number of treated vessels was also lower in females (2.5 vs. 2.6 for CABG; 1.2 vs. 1.3 for PCI), probably reflecting suboptimal revascularization.\u003c/p\u003e\u003cp\u003eDespite all patients being first-time stable CCS cases, our mortality findings after cardiac surgery are consistent with previous studies [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Yet, a central unresolved issue is the paradox that, while males have a marginally higher IHD prevalence, they consistently show lower mortality\u0026mdash;even though females undergo fewer revascularizations. This supports existing evidence that cardiovascular disease is often diagnosed later in females, possibly due to their more atypical symptom presentation [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], leading to delays in investigation and treatment.\u003c/p\u003e\u003cp\u003eIn Denmark, males account for 61% of IHD patients [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], closely matching their 59.2% representation among 219,377 first-time entries in the Western Denmark Heart Registry undergoing CTA or ICA. Females comprise 40.8% of these diagnostic procedures but only 25% of revascularizations, a gap not readily explained. Interestingly, females contribute 43.9% of referrals from primary care slightly above their IHD prevalence suggesting equitable referral practices in the primary sector. Therefore, underrepresentation of females in revascularization is likely a sorting out after the diagnostic stage. Only 11.4% of the 89,414 females undergoing CTA/ICA proceeded to revascularization, compared to 23.4% of 129,963 males more than double, ultimately resulting in only one in four undergoing revascularizations being female.\u003c/p\u003e\u003cp\u003eAlthough females had slightly fewer coronary arteries investigated and a marginally lower degree of stenosis, these differences are unlikely to explain the disparity in revascularization rates. Their mixed comorbidity profile\u0026mdash;with fewer previous MIs and better LV function, but more diabetes, older age, and acute presentations\u0026mdash;shows no consistent pattern or bias to explain referral decisions post-ICA.\u003c/p\u003e\u003cp\u003eAcross all time points, mortality remained higher in females than males, and males even outperformed the background population after both CABG and PCI. Despite some improvement in female outcomes over the past two decades [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], overall mortality remains higher in females, with an excess of 7.8 deaths per 1,000 compared to 3.9 in males [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. While absolute IHD mortality rates are higher in male, particularly at younger ages, risk-adjusted mortality is often higher in females - suggesting fewer females develop IHD, but when they do, they face a higher risk of dying from it [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This is also reflected in the slightly higher complication rates and co-morbidities among females.\u003c/p\u003e\u003cp\u003eAs expected, the number of treated vessels significantly differed across procedures: CABG typically involved multiple grafts, while PCI was more often single-vessel procedures. Although overall survival appeared higher after PCI, stratification by number of treated vessels revealed that multi-vessel PCI had the poorest survival and the highest rate of re-intervention. Our findings thus support that CABG and PCI are viable treatment options. Still, CABG may offer superior long-term outcomes, particularly regarding survival and reduced need for re-intervention [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eA key asset of this study is its large, representative cohort from WDHR, which enhances the generalizability and reliability of the findings. The primary strengths are mandatory and obligatory prospectively reported data from a well-established uptake area and a common database used by all institutions. The large cohort with detailed and complete follow-up data on all patients undergoing CABG and PCI over 2 decades allows robust estimations of patients, results, and adverse events.\u003c/p\u003e\u003cp\u003eNevertheless, our study has intrinsic limitations, as we cannot discard its non-randomized nature and that the additional effects of missing covariates and the lack of randomization, potentially increase the risk of confounding. Thus, the observational and retrospective nature of the data introduces potential biases and confounding factors. The uniform treatment practices in Denmark with a vell organised and public funded health system reduce variability but perhaps limits country generalisation. The long study period poses challenges from possible changes in clinical procedures. Additionally, including the study population in the background population mortality data may minimally skew comparisons, though exclusion was not feasible in the current study.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDespite being referred for coronary diagnostication according to their IHD prevalence, females receive revascularization treatment less often and have a substantially higher mortality after revascularization than males, which becomes especially evident when correlating with the mortality of the background population. In multivessel treatments, CABG might often the best alternative.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eACS Acute coronary syndrome\u003c/p\u003e\u003cp\u003eCABG Coronary arterial bypass grafting\u003c/p\u003e\u003cp\u003eCCS Chronic coronary syndrome\u003c/p\u003e\u003cp\u003eCTA Computed tomography angiography\u003c/p\u003e\u003cp\u003eCPR Civil personal registration\u003c/p\u003e\u003cp\u003eCVD Cardiovascular disease\u003c/p\u003e\u003cp\u003eICA Invasive coronary angiography\u003c/p\u003e\u003cp\u003eICD-10 International classification of diseases, 10th revision\u003c/p\u003e\u003cp\u003eICU Intensive care unit\u003c/p\u003e\u003cp\u003eIHD Ischaemic heart disease\u003c/p\u003e\u003cp\u003ePCI Percutaneous coronary intervention\u003c/p\u003e\u003cp\u003eTAVR Transcatheter aortic valve replacement\u003c/p\u003e\u003cp\u003eWDHR Western Denmark Heart Registry\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/em\u003eDatabase study registered by the Danish Data Protection Agency (1-16-02-455-21). According to Danish legislation, consent is not required for registry-based studies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003cem\u003e:\u003c/em\u003e All authors consent for publication in the BMI journal\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials:\u003c/em\u003e\u0026nbsp; The datasets generated for use in the current study are not publicly available as part of the Danish patient/hospital system, but limited blinded data are available from the corresponding author on reasonable request and subsequent permissions from hospital/database managers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting Interests:\u0026nbsp;\u003c/em\u003eThe authors have no competing interest\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding:\u003c/em\u003e Except support from authors clinics, no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDisclosures\u003c/em\u003e: The authors have nothing to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003cem\u003e:\u003c/em\u003e Jakobsen and Bhavsar study design; Jakobsen data acquisition and analysis; Bhavsar, Jakobsen, Tang, Kjaergaard-Andersen and Thuesen writing and critical review.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgement:\u003c/em\u003e We acknowledge the help of the English language expert form the South Denmark university and the assistance in refining the language of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 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National Institute of National Health, University of Southern Denmark; 2022; 288\u0026ndash;290. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ft.dk/samling/20222/almdel/suu/bilag/107/2670755.pdf\u003c/span\u003e\u003cspan address=\"https://www.ft.dk/samling/20222/almdel/suu/bilag/107/2670755.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRomeo B, Bergami M, Cenko E, Manfrini O, Bugiardini R. Sex disparities in ischemic heart disease mortality in Europe. JACC: Adv. 2024;3:101252. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003edoi.org/10.1016/j.jacadv.2024.101252\u003c/span\u003e\u003cspan address=\"10.1016/j.jacadv.2024.101252\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSpadaccio C, Benedetto U. Coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in the treatment of multivessel coronary disease: quo vadis? - a review of the evidences on coronary artery disease. Ann Cardiothorac Surg. 2018;7:506\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.21037/acs.2018.05.17\u003c/span\u003e\u003cspan address=\"10.21037/acs.2018.05.17\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"cardiovascular diseases, coronary artery disease, healthcare disparities, ischemic heart disease, gender differences, coronary arterial bypass grafting, percutaneous coronary intervention","lastPublishedDoi":"10.21203/rs.3.rs-7657148/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7657148/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIschemic heart disease (IHD) is, despite improvement last decades, still a leading cause of death globally. Clinical IHD guidelines do not distinguish between genders, although females experience higher mortality. This study aimed to investigate gender and procedure disparities after revascularization in patients with chronic coronary syndrome (CCS) and further correlate findings to the background population mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included 40,565 first entry revascularizations by CABG or PCI from 2000–2020 obtained from Western Denmark Heart Registry. Kaplan-Meier survival curves evaluated mortality and re-intervention free survival, and logistic regression analysed the impact of identified risk factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFemales experienced revascularization substantially less often than males. All-cause 10-years mortality were higher in females after both CABG 1.15 (1.06–1.25) and PCI 1.17 (1.11–1.23), Males had marginally higher 10-years mortality after CABG compared to PCI (1.04 (1.00-1.10)), while no difference in females (1.03 (0.95–1.13)). Further, males had better survival than the background population, three years after both CABG and PCI, while females after PCI surpassed the population survival after six years but never reached the background population after CABG. Regarding the number of treated vessels/grafts single-PCI had lowest mortality followed by CABG, while 3-vessel PCI had the highest mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite being referred for coronary diagnostication according to their IHD prevalence, females receive revascularization treatment less often and have a substantially higher mortality after revascularization than males.\u003c/p\u003e","manuscriptTitle":"Sex disparities in coronary re-vascularisation and mortality","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-10 15:10:21","doi":"10.21203/rs.3.rs-7657148/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-08T03:31:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-04T19:10:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-04T16:45:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"70821173515153738584468101529624855993","date":"2025-09-29T15:33:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337920111745807846354867436697320060119","date":"2025-09-28T22:20:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-27T15:18:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-23T01:35:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-23T01:34:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-09-19T09:37:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"854aef83-7397-4170-86e3-a8bf87499fd9","owner":[],"postedDate":"October 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:21:22+00:00","versionOfRecord":{"articleIdentity":"rs-7657148","link":"https://doi.org/10.1186/s12872-026-05688-x","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2026-03-25 16:10:25","publishedOnDateReadable":"March 25th, 2026"},"versionCreatedAt":"2025-10-10 15:10:21","video":"","vorDoi":"10.1186/s12872-026-05688-x","vorDoiUrl":"https://doi.org/10.1186/s12872-026-05688-x","workflowStages":[]},"version":"v1","identity":"rs-7657148","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7657148","identity":"rs-7657148","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}