**Abstract**

With the increasing incidence of coronary artery disease, the percutaneous coronary intervention (PCI) has become one of the most effective treatments for coronary artery disease. After more than 40 years of clinical application, development and research, and continuous improvement, it has been widely used around the world. In recent years, due to the continuous innovation of drug-eluting stents, equipment, drugs, and interventional technology, the indications for treatment have been continuously broadened, many heart centers can deal with complete revascularization for high-risk indicated patient session, and the efficacy has been further improved. However, studies have shown that there are gender differences in the clinical prognosis of patients with coronary artery disease after percutaneous coronary intervention, which are affected by many related risk factors of gender differences, but there is lack of systematic and comprehensive review of relevant factors. The purpose of this review is to evaluate the possible causes of gender differences in the clinical outcomes of patients after percutaneous coronary intervention and to put forward recommendations for primary prevention and secondary prevention.

**Keywords:** coronary artery disease, percutaneous coronary intervention, gender, differences

## **1. Introduction**

Coronary artery disease is the most common cardiovascular disease caused by myocardial ischemia, hypoxia, and necrosis due to coronary stenosis, spasm, or occlusion. Since the first application of percutaneous coronary intervention (PCI) to myocardial infarction by Gruentzig in 1977, it has become the most common method to recover myocardial reperfusion under various states, significantly improving the survival and quality of life of patients with coronary artery disease [1]. Notably, PCI has been considered as the cornerstone of management for

patients with or without ST elevation acute coronary syndromes [2–4]. In the past two decades, with the emergence of drug-eluting stent, the indication of PCI in high-risk patients with coronary artery disease has been tremendously broadened. In recent years, the progress of interventional techniques has also fundamentally changed the treatment of coronary artery disease. Moreover, since balloon angioplasty has been used in patients with coronary artery disease, the influence of gender on clinical outcomes after PCI has been continuously investigated. In particular, previous studies have reported that the incidence of adverse outcomes in female patients with coronary artery disease after PCI is higher than that in male patients with those after PCI, including short- and long-term mortality, major adverse cardiovascular events (MACE), and revascularization. On the one hand, some studies have shown that gender differences in clinical outcomes persist after adjusting for multivariate factors, such as age, prior peripheral vascular disease, prior myocardial infarction, prior PCI, and chronic renal failure [5–8]. On the other hand, other studies have demonstrated that gender is not an independent factor in the clinical outcome [9–11]. Due to the protection of estrogen, a large number of studies have revealed that the onset age of female patients with coronary artery disease is approximately 5–10 years later than that of male patients with those. Additionally, the prevalence of hypertension, diabetes mellitus, and hyperlipidemia was higher in female individual than that in male individual, while the prevalence of former or current smokers was more in male individual. Therefore, the purpose of the present review is to summarize the gender differences in clinical studies of patients with coronary artery disease after PCI and to put forward suggestions for improving primary and secondary prevention strategies.
