Sex differences in outcomes after cardiac catheterization: effect modification by treatment strategy and time

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.