Mortality Differences Between Men and Women After Percutaneous Coronary Int
Mortality Differences Between Men and Women After Percutaneous Coronary Int
Objectives: Our aim was to examine whether gender-based differences in mortality after percutaneous coronary interventions (PCIs) have changed in the past 25 years.
Background: Women with coronary artery disease have a higher risk of adverse outcomes after PCIs than do men. Recent temporal trends in short-term and long-term mortality in women after PCIs are unknown.
Methods: We performed a retrospective cohort study of 18,885 consecutive, unique patients who underwent PCIs between 1979 and 1995 (early group, n = 7,904, 28% women) and between 1996 and 2004 (recent group, n = 10,981, 31% women). Thirty-day and long-term mortality were compared by gender.
Results: Compared with men, women undergoing PCIs were older and more likely to have diabetes mellitus, hypertension, or hypercholesterolemia. Overall, PCI was successful in 89% of women and 90% of men. In the recent group, 30-day mortality was significantly reduced compared with that in the early group in women (2.9% vs. 4.4%, p = 0.002) and men (2.2% vs. 2.8%, p = 0.04). However, long-term survival was similar between the early and recent groups among both men and women. After adjustment for risk factors, there was no difference between men and women from 1994 onward for either 30-day or long-term outcomes.
Conclusions: The 30-day mortality after PCI in men and women has decreased in the past 25 years. After accounting for baseline risks, no differences in short-term or long-term mortality were observed between men and women.
Heart disease is the leading cause of death in women—approximately 400,000 deaths annually. In the U.S., around 30% of the approximately 1 million annual percutaneous coronary intervention (PCI) procedures are performed in women. It is important, therefore, to carefully document the outcomes of women undergoing this procedure.
Women undergoing PCI are known to have a higher incidence of adverse outcomes than men. However, the results of risk-adjusted analyses of short-term and long-term outcomes after PCI are discordant with earlier studies demonstrating an adverse prognosis in women; more recent data indicate narrowing of the gender gap. Prior studies have shown that women undergo PCI later in the course of disease, have more comorbid conditions, and have more technically challenging coronary anatomy.
Most studies reporting on the gender-based differences in outcomes after PCI date from the early to mid-1990s. Coronary interventional practice since 1995 has been revolutionized with stents, combination oral antiplatelet therapy, glycoprotein IIb/IIIa inhibitors, and, even more recently, drug-eluting stents. To address the hypothesis that the gender gap in outcomes after PCI has narrowed, we performed an analysis of the Mayo Clinic PCI registry data: 1) to characterize the current (1996 to 2004) practice and outcomes of PCI in women; 2) to compare current practice with past (1979 to 1995) practice; and 3) to compare the experience of women and men.
Objectives: Our aim was to examine whether gender-based differences in mortality after percutaneous coronary interventions (PCIs) have changed in the past 25 years.
Background: Women with coronary artery disease have a higher risk of adverse outcomes after PCIs than do men. Recent temporal trends in short-term and long-term mortality in women after PCIs are unknown.
Methods: We performed a retrospective cohort study of 18,885 consecutive, unique patients who underwent PCIs between 1979 and 1995 (early group, n = 7,904, 28% women) and between 1996 and 2004 (recent group, n = 10,981, 31% women). Thirty-day and long-term mortality were compared by gender.
Results: Compared with men, women undergoing PCIs were older and more likely to have diabetes mellitus, hypertension, or hypercholesterolemia. Overall, PCI was successful in 89% of women and 90% of men. In the recent group, 30-day mortality was significantly reduced compared with that in the early group in women (2.9% vs. 4.4%, p = 0.002) and men (2.2% vs. 2.8%, p = 0.04). However, long-term survival was similar between the early and recent groups among both men and women. After adjustment for risk factors, there was no difference between men and women from 1994 onward for either 30-day or long-term outcomes.
Conclusions: The 30-day mortality after PCI in men and women has decreased in the past 25 years. After accounting for baseline risks, no differences in short-term or long-term mortality were observed between men and women.
Heart disease is the leading cause of death in women—approximately 400,000 deaths annually. In the U.S., around 30% of the approximately 1 million annual percutaneous coronary intervention (PCI) procedures are performed in women. It is important, therefore, to carefully document the outcomes of women undergoing this procedure.
Women undergoing PCI are known to have a higher incidence of adverse outcomes than men. However, the results of risk-adjusted analyses of short-term and long-term outcomes after PCI are discordant with earlier studies demonstrating an adverse prognosis in women; more recent data indicate narrowing of the gender gap. Prior studies have shown that women undergo PCI later in the course of disease, have more comorbid conditions, and have more technically challenging coronary anatomy.
Most studies reporting on the gender-based differences in outcomes after PCI date from the early to mid-1990s. Coronary interventional practice since 1995 has been revolutionized with stents, combination oral antiplatelet therapy, glycoprotein IIb/IIIa inhibitors, and, even more recently, drug-eluting stents. To address the hypothesis that the gender gap in outcomes after PCI has narrowed, we performed an analysis of the Mayo Clinic PCI registry data: 1) to characterize the current (1996 to 2004) practice and outcomes of PCI in women; 2) to compare current practice with past (1979 to 1995) practice; and 3) to compare the experience of women and men.
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