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Differences in prognostic factors and outcomes between women and men undergoing coronary artery stenting
J Mehilli1, A Kastrati, J Dirschinger
1Deutsches Herzzentrum, Lazarettstr 36, 80636 Munich, Germany.
Insights
Women with coronary artery disease (CAD) undergoing coronary stenting have similar outcomes to men at one year. However, women face higher early risks, with diabetes being a key prognostic factor, unlike men where age is more critical.
Area of Science:
- Cardiology
- Interventional Cardiology
- Sex-Based Medicine
Background:
- Coronary artery disease (CAD) management traditionally focused on male-specific risks.
- Women with CAD may experience worse outcomes post-intervention compared to men.
- The impact of coronary stenting on sex-based outcomes requires further investigation.
Purpose of the Study:
- To investigate sex-based differences in prognostic factors.
- To compare early and late outcomes in men versus women post-coronary stenting.
Main Methods:
- Inception cohort study including 1001 women and 3263 men with symptomatic CAD.
- Coronary stent placement was performed between May 1992 and December 1998.
- Combined event rates of death and nonfatal myocardial infarction were assessed at 30 days and 1 year.
Main Results:
- Women were older and had higher rates of diabetes, hypertension, and hypercholesterolemia than men.
- Women showed an increased early risk of death or myocardial infarction (3.1% vs 1.8% at 30 days; adjusted HR 2.02).
- At 1 year, outcomes were similar between sexes (6.0% vs 5.8%; adjusted HR 1.06), with diabetes being a key factor for women and age for men.
Conclusions:
- One-year outcomes after coronary stenting are comparable for women and men with CAD.
- Significant sex-specific differences exist in baseline characteristics, clinical course, and prognostic factors.
- Understanding these differences is crucial for personalized CAD management in women.
Context:
Women with coronary artery disease (CAD) are believed to have a higher risk for adverse outcomes than men after conventional coronary interventions. The increasing use of coronary stenting has improved the outcome of patients undergoing coronary interventions, but little is known about the nature of outcomes in men vs women after this procedure.
Objective:
To examine whether there are sex-based differences in prognostic factors and in early and late outcomes among CAD patients undergoing coronary stent placement.
Design, Setting, And Patients:
Inception cohort study, at 2 tertiary referral institutions in Germany. Consecutive series of 1001 women and 3263 men with symptomatic CAD who were treated with stenting between May 1992 and December 1998. Patients who underwent stenting in the setting of acute myocardial infarction were excluded.
Main Outcome Measure:
The combined event rates of death and nonfatal myocardial infarction, assessed at 30 days and 1 year after stenting and compared by sex.
Results:
Compared with men, women undergoing coronary stenting were significantly older (mean age, 69 vs 63 years) and more likely to present with diabetes, arterial hypertension, or hypercholesterolemia. Women had less extensive CAD, a less frequent history of myocardial infarction and better preserved left ventricular function than men. Women presented an excess risk of death or nonfatal myocardial infarction only during the early period after stenting: the 30-day combined event rate of death or myocardial infarction was 3.1% in women and 1.8% in men (P =.02) and the multivariate-adjusted hazard ratio (HR) for women was 2.02 (95% confidence interval [CI], 1.27-3.19). At 1 year, the outcome was similar for both women and men (combined event rate for women, 6.0%, and for men, 5.8% (P =.77); multivariate-adjusted HR for women, 1.06 [95% CI, 0.75-1.48]). There was a sex difference in the prognostic value of baseline characteristics: the strongest prognostic factors were diabetes in women and age in men.
Conclusions:
The results of this study indicate that 1-year outcomes of women with CAD undergoing coronary artery stenting are similar to those of men. Despite the similarity in outcomes, there are several sex-specific differences in baseline characteristics, clinical course after the intervention, and relative weight of prognostic factors. JAMA. 2000;284:1799-1805.
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