News:A large study demonstrates no gender differences in short- and long-term outcomes following PCI
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June 10, 2008 By Vijayalakshmi Kunadian MBBS MD MRCP [1]
JACC: A new study demonstrates no difference in short-term and long-term mortality among men and women following PCI with improved 30-day mortality rates in the past 25 years.
Previous studies document that women tend to have a higher incidence of adverse events compared with men following percutaneous coronary intervention (PCI). This was further explored by Singh and coworkers from the Mayo clinic. In a recent publication in JACC, the investigators studied 18,885 patients who underwent PCI between 1979 and 1995.
This retrospective study was conducted to determine the differences in outcomes in terms of mortality between men and women and also to determine if the outcomes have improved over time. The total patient population was divided into two groups: 1. early group-patients who underwent PCI between 1979 and 1995 (n=7904: women 2203, men 5701) and 2. recent group- patients who underwent PCI between 1996 and 2004 (n=10981: women 3365, men 7616).
In both groups, women were older and had severe symptoms of coronary heart disease, more heart failure and more frequent presentation with acute coronary syndromes. Diabetes mellitus and hypertension were more prevalent among women than men. Secondary prevention medications were more frequently used in the recent group compared with the early group. Stents and glycoprotein IIbIIIa inhibitors were more frequently used in the recent group.
Procedural success was slightly lower in the early group (women 82.7% vs. men 84.3%) compared with the recent group (women 93.4% vs. men 93.9%), p interaction=0.80. The 30-day mortality in the early group (women 4% vs. men 3%) was higher than the recent group (women 3% vs. men 2%), p<0.001. Furthermore, the mortality was greater in the early group compared with recent group among women (p=0.002) and men (p=0.04). 5 year follow-up demonstrated that the probability of survival was 79% and 81% among women compared with men (83% and 83%) in the early and recent groups respectively. The adjusted (after adjusting for risk factors) and unadjusted analysis demonstrated that there was no significant difference in the 30-day (p=0.10) and 1 year mortality (p=0.42) between men and women.
The authors conclude that following PCI, 30-day and long-term mortality among men and women has decreased in the past 25 years. After adjustment for risk factors, the survival rates were comparable between men and women. This study however is limited by the fact that it is retrospective and reflects experience from a single center.
