Introduction: Ischemic heart disease (IHD) is a leading cause of death globally. Despite clinical guidelines for treating IHD do not differentiate between sexes, females experience higher mortality compared to males. This study aimed to investigate sex disparities in mortality after standard percutaneous coronary intervention (PCI) for IHD and compare to the background expected population mortality.

Methods: The study included 84,335 patients treated with first entry PCI from Western Denmark Heart Registry (2000-2021). Kaplan-Meier survival curves evaluated mortality over time, and logistic regression analyses identified risk factors.

Results: All-cause mortality was higher in females at 30 days (4.54% vs. 3.43%), 1 year (8.24% vs. 6.42%), and 5 years (20.47% vs. 16.48%) (p<0.0001). Compared to the background population mortality, there was a considerable difference between actual and expected 1- and 5-year mortality among males and females following PCI and, despite general longer living time, a significantly higher expected mortality in females compared to males. Males had a better survival than the background population after six years, regardless of the indication for PCI, while females displayed comparable mortality to the background population at eight years. Female sex was associated with higher mortality after 30 days, 1 year, and 5 years, respectively (OR 1.65 (1.47-1.87), OR 1.43 (1.33-1.55), and OR 1.37 (1.30-1.44)).

Conclusion: Females experience higher mortality following first entry PCI compared to males. Additionally, they have a higher expected mortality and a delayed catch-up with the background population mortality relative to males.