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The aim of this observational, retrospective analysis was to close this lack of evidence. Between January 2007 and February 2021, a total of 3511 patients with 5497 in-stent restenosis (ISR) lesions were treated at two large-volume centers in Munich, Germany, of which 763 (21.7%) were female. Endpoints of interest were all-cause mortality and rates of repeat revascularization. Outcomes are presented as Kaplan\u2013Meier event rates. Univariate and multivariate analyses were performed. Female patients were older (72.1\u2009\u00b1\u200910.4 versus 68.4\u2009\u00b1\u200910.4 years, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and suffered more often from diabetes (38.8% versus 34.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.029). There was no statistical difference regarding the clinical presentation and interventional treatment strategy. After 10 years, the risk of all-cause mortality was higher in female patients [hazard ratio (HR) 1.18 (1.02\u20131.35); <jats:italic>p<\/jats:italic>\u2009=\u20090.022]; however, after adjustment for age, the risk did not differ significantly between both sexes [adjusted HR 0.96 (0.83\u20131.11); <jats:italic>p<\/jats:italic>\u2009=\u20090.6]. Regarding target vessel revascularization (TVR) and non-target vessel revascularization (NTVR), the risk was lower in female patients [HR 0.73 (0.61\u20130.87); <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 and HR 0.74 (0.64\u20130.86); <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001] even after age adjustment. No statistical differences were found regarding the risk of target lesion revascularization, target vessel myocardial infarction and stent thrombosis. In the long term, all-cause mortality after percutaneous coronary intervention of DES-ISR did not differ between both sexes after age adjustment. The risk of TVR and NTVR was lower in female patients even after age adjustment.<\/jats:p>\n          <jats:p>\n            <jats:bold>Graphical abstract<\/jats:bold>\n          <\/jats:p>","DOI":"10.1007\/s12928-025-01092-y","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T12:29:58Z","timestamp":1738585798000},"page":"316-326","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sex-related outcomes after percutaneous coronary intervention of in-stent restenosis"],"prefix":"10.1007","volume":"40","author":[{"given":"Constantin","family":"Kuna","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Bradaric","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Schroeter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Presch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Voll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Kufner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tareq","family":"Ibrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heribert","family":"Schunkert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Ludwig","family":"Laugwitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Cassese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Kastrati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4170-7347","authenticated-orcid":false,"given":"Jens","family":"Wiebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,3]]},"reference":[{"key":"1092_CR1","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1093\/ehjqcco\/qcac014","volume":"8","author":"A Timmis","year":"2022","unstructured":"Timmis A, Vardas P, Townsend N, Torbica A, Katus H, De Smedt D, Gale CP, Maggioni AP, Petersen SE, Huculeci R, et al. 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Sebastian Kufner reports speaker and consulting fees from AstraZeneca, Bristol-Myers Squibb, and Bentley and speaker fees from Abbott, Boehringer-Ingelheim and Translumina and a research grant from Bentley, not related the current work. Heribert Schunkert has received lecture fees from AstraZeneca, Bayer Vital, Novartis, Servier, Sanofi-Aventis, Synlab, Bristol-Myers Squibb and Amarin, consulting fees from Amgen, AstraZeneca, Boehringer-Ingelheim, Daiichi-Sankyo and Servier and external funds from AstraZeneca, St. Jude and Boston Scientific. Jens Wiebe reports lecture fees from AstraZeneca, Translumina and Abbott Vascular and received Institutional Research Grant support from Abbott Vascular. The other authors have no relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}