Influence of Gender on Long-Term Outcomes After Implantation of Bare-Metal Stent: A Multicenter Report From the Coronary Revascularization Demonstrating Outcome Study-Kyoto (CREDO-Kyoto) Registry Cohort-1
Background—Female gender was reported to be associated with lower risk for mid-term restenosis and repeat revascularization after bare metal stent (BMS) implantation. However, the influence of gender on very long-term outcomes after BMS implantation has not been yet reported.
Methods and Results—Among the 9877 patients in the multicenter CREDO-Kyoto registry cohort-1, BMS implantation was performed in 5313 patients (men: N=3742 and women: N=1571). Follow-up was completed in 4515 patients (85.0%) at 10-year (duration:10.3±3.1[0.0-14.1]years). The cumulative incidence of target-lesion revascularization (TLR) was 27% at 1-year, and 34% at 10-year (0.8%/year beyond 1-year). Non-target-lesion revascularization (non-TLR) was the dominant coronary revascularization beyond 1-year (13% at 1-year, and 31% at 10-year [2.0%/year beyond 1-year]). Cumulative incidence of stent thrombosis (ST) was low (1.2% at 1-year, and 1.9% at 10-year). Women were older and had greater prevalence of cardiovascular risk factors than men. The cumulative 10-year incidences of and adjusted risk for TLR was significantly higher in men than in women (36% versus 30%, P<0.001, and adjusted HR 1.29 [95%CI 1.15-1.46], P<0.001). The higher risk of men relative to women for TLR was consistent regardless of age (<75 years, and ≥75 years). Men as compared with women were also associated with significantly higher adjusted risks for all-cause death, myocardial infarction (MI), stroke, CABG, TLR and non-TLR.
Conclusions—TLR and ST continued to occur without attenuation up to 10-year after BMS implantation. Men as compared with women were associated with higher adjusted 10-year risks for all-cause death, MI, stroke, CABG, TLR, and non-TLR.
- Received April 28, 2015.
- Revision received September 16, 2015.
- Accepted October 2, 2015.