Abstract 13203: Gender Difference in Clinical Characteristics and Outcomes of Japanese Patients Undergoing Coronary Revascularization Therapy in Drug Eluting Stent Era
Background: Limited data are available for sex-based differences in patients undergoing coronary revascularization in the drug-eluting stent (DES) era.
Purpose: To identify sex-based differences in risk factor profiles and outcomes among Japanese patients undergoing first coronary revascularization in the DES era.
Methods: The CREDO-Kyoto PCI/CABG registry cohort-2 is a multi-center registry enrolling consecutive patients undergoing first percutaneous coronary intervention or coronary artery bypass grafting in 2005-2007 at 26 hospitals in Japan. The study subjects consisted of 2640 women and 6675 men enrolled in the registry. Patients with malignant disease were not included. The outcome measures were all-cause death (AD), cardiovascular death (CVD), any coronary revascularization procedure (ACR) and major adverse cardiovascular events (MACE) as the composite of CVD, myocardial infarction and stroke.
Results: A mean follow-up period was 1087 days. Women were older than men and more frequently had histories/comorbid conditions of insulin-dependent diabetes, hypertension, chronic kidney disease, multivessel disease, anemia and hyper-LDL-cholesterolemia. Cumulative incidence of CVD was significantly higher and ACR was lower in women than in men at 3 years (CVD, 5.9% vs. 4.2%, log-rank p=0.004; ACR, 24.7% vs. 27.9%, p=0.005). No significant sex-based differences were shown in the cumulative incidences of AD and MACE at 3 years (AD, 7.8% vs. 7.1%, p=0.19; MACE, 11.1% vs. 10.1%, p=0.21). Multivariate Cox proportional hazard analysis indicated that female sex was associated with significantly lower adjusted risk for ACR relative to male sex [relative risk (RR) 0.84, 95% confidence interval (CI) 0.77-0.92, p=0.0002]. The risks for AD (RR 0.85, 95% CI 0.71-1.02, p=0.071), CVD (RR 1.08, 95% CI 0.86-1.34, p=0.50) and MACE (RR 0.98, 95% CI 0.84-1.13, P=0.75) were comparable between women and men after adjustments.
Conclusions: The coronary risk factor burden appeared greater in women than in men among Japanese patients undergoing first coronary revascularization. Despite the greater modifiable risk factor accumulation, female-sex was associated with lower incidence of repeated revascularization in the DES era.
- © 2011 by American Heart Association, Inc.