Abstract 3494: Gender Differences In Hospital Mortality After Percutaneous Coronary Intervention
Objectives Previous studies have shown higher in-hospital mortality in women than in men after PCI for acute coronary syndrome (ACS). The assessment of whether the excess risk is related to the disease seriousness, the management of patients, the use of PCI or a higher baseline risk of patients remains to be determined. The aim of this study was to assess whether in-hospital deaths and composite outcomes of patients undergoing PCI are related to gender during the first 48 hours.
Methods During two years (2005–2006), 5130 consecutive PCI were performed in our University Department of Cardiology, of which 1414 were urgent procedures and 3716 were non-urgent. The primary end-point was death and the second a composite of major adverse cardiovascular events: stroke, emergency CABG surgery, recurrent myocardial infarction, new PCI and renal or vascular complications. The association between gender and in-hospital outcomes was analyzed for urgent and non-urgent procedures separately and was assessed using multivariate logistic regression and propensity score analysis.
Results The proportion of women was 23.0% (n = 325) and 23.6% (n = 876) in urgent and non-urgent procedures respectively. The percentage of deaths was 4.9% in women and 1.4% in men for urgent PCI (p = 0.0001) and 0.6% and 0.5% in non-urgent PCI respectively (p = 0.78). The composite outcome was 3.2% in women and 2.6% in men (p = 0.64) for urgent PCI and 1.2% and 1.4% (p = 0.67) respectively for non-urgent PCI. The risk (OR [95% CI]) of in-hospital death for women vs. men was 2.58 ([1.19 –5.62], p = 0.02) for urgent PCI and 0.80 ([0.28 –2.31], p = 0.69) for non urgent PCI, after adjustment for age, histories of MI and PCI, year of procedure, renal failure, diagnosis of MI, number of vessel disease and number of treated coronary arteries. The propensity score analysis for 310 matched pairs for urgent PCI and 868 for non-urgent PCI confirms the results: the risks of death for women were 3.78 ([1.18 –12.1], p = 0.03) and 0.88 ([0.22–2.19], p = 0.52) respectively.
Conclusion Women with ACS who undergo PCI have a higher in-hospital mortality rate than men. In non-urgent procedure the risk of death is similar to men. No excess risk for other complications has been observed.