Women have a higher peri-procedural risk during percutaneous coronary intervention than men but similar long-term outcomes

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A large cohort study, published ahead of print in Circulation, indicates that women undergoing percutaneous coronary intervention (PCI)—either with a bare metal stent or a drug-eluting stent—have a significantly increased risk of in-hospital death or peri-procedural myocardial infarction compared with men undergoing a PCI procedure. However, they have better or similar long-term outcomes.

Monique Anderson, Duke University Medical Center, Durham, USA, and others reported that, at present, it is currently unclear whether there are differences in-hospital outcomes or long-term outcomes between men and women undergoing PCI. Therefore, they evaluated short- and long-term data for 426,996 patients (180,752 women) who had undergone PCI (74.5% of women and 73.2% of men received a drug-eluting stent) between January 2004 and December 2008.

Anderson et al found that women experienced higher rates of all-cause in-hospital mortality (adjusted odds ratio 1.41), and were more likely to experience a peri-procedural myocardial infarction (adjusted odds ratio 1.19), bleeding (adjusted odds ratio 1.86), and vascular complications (adjusted radio 1.86) than men. The authors added: “Women also carried higher adjusted rates of incident chronic heart failure (odds ratio 1.59), cardiogenic shock (odds ratio 1.59), cerebrovascular accident (odds ratio 1.59), and renal failure (odds ratio 1.25).”

However, after 30 months of follow-up, women had a lower risk of death, a similar risk of myocardial infarction, and a similar risk of bleeding compared to men. Furthermore, when Anderson et al compared long-term outcomes of patients who received a drug-eluting stent with those who received a bare metal stent, they found that drug-eluting stents were associated with a lower risk of death, myocardial infarction, and revascularisation in both men and women with no significant differences (in terms of benefit received) between the sexes observed.

Anderson et al commented that, although the evidence is conflicting, data do suggest that women are more likely to experience in-hospital mortality and complications with PCI. They wrote: “Various studies have hypothesised that this increased risk is due to a greater burden of comorbidities, older age, smaller body size, and/or less aggressive pharmacologic therapy. Yet in our study, women remained at a significantly increased risk despite extensive adjustment for more than fifty clinical variables.” They added that potential reasons for this continued difference in risk may be because of unmeasured factors, such as delays in seeking or receiving care or differences in the percutaneous intervention itself. Anderson et al added: “While absolute number of complications and deaths during the peri-procedural period were low, sex still remains a significant risk factor for in-hospital death and complications, and emphasises the need for continued study in this area.”

Reviewing the similarities between the sexes in long-term outcomes, Anderson et al wrote: “It is possible that once women are identified as having coronary artery disease, they may receive increased aggressive secondary preventative care and attention to recurrent symptomatic coronary artery disease (as evidence by revascularisation rates) thereby resulting in similar long-term clinical outcomes compared with men in the contemporary stenting era.”