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Sex differences in outcomes after cardiac catheterization: effect modification by treatment strategy and time
Kathryn M King1, William A Ghali, Peter D Faris
1Faculty of Nursing, University of Calgary, Alberta, Canada. kingk@ucalgary.ca
Insights
Sex differences in cardiac catheterization mortality are time- and treatment-specific. While women initially face higher risks with procedures like CABG and PCI, these differences diminish over time, becoming equivalent before one year.
Area of Science:
- Cardiovascular medicine
- Clinical outcomes research
- Sex-based health disparities
Background:
- Existing studies on sex differences in cardiac care outcomes present conflicting results.
- Some research indicates worse outcomes for women, while others suggest equivalent results.
Purpose of the Study:
- To investigate if coronary disease extent, treatment strategy, and follow-up duration affect mortality risk in women versus men post-cardiac catheterization.
- To clarify discrepancies in previous research on sex-based cardiac care outcomes.
Main Methods:
- Analysis of a large inception cohort (37,401 patients) from Alberta, Canada (1995-2000), with follow-up through 2001.
- Stratified risk assessment by coronary artery disease severity and treatment (no revascularization, PCI, CABG).
- Evaluation of time-dependent relative risk of death for women compared to men.
Main Results:
- Women exhibited higher 1-year mortality than men (5.6% vs 4.6%).
- Sex-based mortality differences were primarily observed early after catheterization, particularly in patients undergoing revascularization (CABG, PCI).
- Risk-adjusted relative risks for women were elevated on day 1 post-procedure but decreased to equivalence before one year.
Conclusions:
- Sex-based disparities in post-cardiac catheterization mortality are specific to the timing and type of treatment received.
- These time- and treatment-dependent differences may explain the varied findings in prior studies on sex differences in cardiac care.
Context:
Studies comparing outcomes of cardiac care in women vs men yield various results, with some suggesting worse outcomes for women and others suggesting equivalent outcomes.
Objective:
To determine whether extent of coronary disease, treatment strategy, and follow-up time influence the risk of death in women vs men among patients who have had cardiac catheterization.
Design, Setting, And Patients:
We studied a large inception cohort by using detailed clinical data from a registry of 37 401 patients undergoing cardiac catheterization in Alberta, Canada, from 1995-2000, with follow-up through December 31, 2001.
Main Outcome Measures:
The risk of death for women vs men was assessed for all patients combined and then in analyses stratified by degree of coronary anatomic risk and by treatment strategy (no revascularization, percutaneous coronary intervention [PCI], coronary artery bypass graft [CABG] surgery). The latter analysis included a graphic assessment of the changing relative risk over time for women vs men.
Results:
Women had higher 1-year mortality than men did (5.6% vs 4.6%; P<.001). However, stratified analyses demonstrated that sex differences in risk occurred only early after catheterization and were most apparent among patients undergoing revascularization. The early risk-adjusted relative risks for women vs men were elevated at 3.49 (95% confidence interval [CI], 1.95-6.24) for CABG surgery and 2.38 (95% CI, 1.48-3.83) for PCI on day 1 after catheterization, with a subsequent decrease in relative risk over time to equivalence in risk between sexes before 1 year.
Conclusions:
Sex-based differences in death rates after cardiac catheterization are time- and treatment-specific. This finding may at least partially explain the discrepancies in results from earlier studies on sex differences in outcomes of cardiac care.
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