Abstract 15384: Women Undergoing Percutaneous Coronary Intervention Continue to Experience Inferior Outcomes Compared to Men Despite Optimal Contemporary Medical Care and Procedural Advances at a High-Volume Tertiary Facility
Introduction: It has previously been reported that women suffer inferior outcomes compared to men after percutaneous coronary intervention (PCI). However, various strategies are now used that may mitigate this imbalance, such as improved medical therapy, closer attention to risk-factors, and technical and procedural advances during PCI. Therefore, we hypothesized that in contemporary practice at a high-volume tertiary centre, women may now experience similar outcomes to men after PCI.
Methods: From the period Apr 2003 – Apr 2009 we identified 16961 patients (5880 female, 11081 male, mean age 69.1 and 64.6 yrs respectively) who underwent PCI at a single high-volume tertiary centre. Baseline, procedural and outcome data were extracted from an IRB-approved database and were imputed for analysis. Unless stated, comparisons are significant at p < 0.0001.
Results: At baseline compared to men, females smoked less (14.4 vs 21.6%), but more were hypertensive (91.8 vs 86.0%) or diabetic (47.1 vs 38.0%). Women had higher HDL (46.6 vs 39.6 mg/dL), but also higher LDL (87.4 vs 82.2 mg/dL) levels. Renal and left ventricular function was better in women (GFR: 97.5 vs 84.7 ml/min; LVEF: 52.4 vs 49.6%), and fewer had suffered prior myocardial infarction (MI) (17.9 vs 21.8%). While more women presented with unstable angina (38.5 vs 34.1%), fewer presented with acute MI (5.1 vs 6.1%, p = 0.007). In women the left anterior descending artery was the more commonly treated vessel (43.0 vs 39.5%), but fewer exhibited AHA class B2 or C lesion morphology (77.2 vs 79.4%). Although many of these variables favored women, compared to men, overall death rates after PCI were higher in females (30 days, 1.3 vs 0.8%, p = 0.01; 1 yr, 6.1 vs 4.8%, p = 0.002; 3 yr, 10.3 vs 8.4%, p = 0.0002). Higher rates of cardiac death and acute MI in women were also observed (at 3 yr, AMI: 3.2 vs 2.3%, p = 0.002; Cardiac death: 1.4 vs 0.9%, p = 0.01). Multivariate regression identified that the significant independent predictors of all cause death at 1 yr post-PCI were female sex, long-term dialysis and peripheral vascular disease, with men having a 20% reduced chance of death (p = 0.007).
Conclusions: Despite multiple advances in procedural technique and clinical management, women continue to experience inferior outcomes after PCI.
- © 2010 by American Heart Association, Inc.