Gender differences and in-hospital mortality in patients undergoing percutaneous coronary interventions
Agnieszka Nowakowska-Arendt1, Zofia Grabczewska, Marek Koziński
1Department of Cardiology and Internal Diseases, A Jurasza University Hospital, Bydgoszcz, Poland.
Insights
Percutaneous coronary intervention (PCI) outcomes in women with coronary artery disease (CAD) show differences compared to men, particularly in acute myocardial infarction (AMI) cases. Cardiogenic shock is a key mortality factor for women post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Observational studies indicate women receive less invasive coronary artery disease (CAD) treatment and have poorer percutaneous coronary intervention (PCI) outcomes than men.
- Existing research suggests gender-based disparities in CAD diagnosis and treatment referrals.
Purpose of the Study:
- To directly compare the outcomes of percutaneous coronary intervention (PCI) between male and female patients.
- To identify demographic, angiographic, and clinical factors influencing hospitalization duration and in-hospital mortality in men and women undergoing PCI.
Main Methods:
- Retrospective analysis of 1000 consecutive patients undergoing PCI for acute myocardial infarction (AMI), unstable angina (UA), or stable angina (SA).
- Examination of demographic data, clinical variables, and angiographic findings.
- Comparative analysis of hospitalization duration and in-hospital mortality stratified by gender and reason for PCI.
Main Results:
- Women, constituting 25.8%-39.6% of PCI patients, were older with higher BMI and more comorbidities (hypertension, diabetes).
- Hospitalization duration was similar for SA/UA but longer for women with AMI.
- While gender itself didn't impact mortality in univariate analysis, multivariate analysis revealed female gender, age, BMI, diabetes, hypercholesterolemia, PCI indication, final TIMI flow, and cardiogenic shock affected mortality. Cardiogenic shock was the sole significant factor for women, whereas men were affected by PCI indication, age, diabetes, and final TIMI flow.
Conclusions:
- Stable angina (SA) is a less frequent indication for PCI in women compared to men.
- Women with CAD present older and with more cardiovascular risk factors.
- In-hospital mortality post-PCI for SA is gender-independent; cardiogenic shock is the primary mortality determinant in women, while men's mortality is influenced by PCI indication, diabetes, and vessel flow.
Background:
Many observational and randomised studies have suggested that women are referred for invasive diagnostics and treatment of coronary artery disease (CAD) less frequently than men, and the effects of percutaneous coronary intervention (PCI) among women are worse than in men.
Aim:
To compare direct results of PCI in men and women.
Methods:
The study was a retrospective assessment of case records of one thousand consecutive patients treated with PCI because of acute myocardial infarction (AMI) (344 patients), unstable angina (UA) (164 patients) and stable angina (SA) (492 patients). We examined the effects of demographic, angiographic and clinical variables on the duration of hospitalisation and in-hospital mortality separately in men and in women.
Results:
Women constituted 30.7% of patients treated with PCI because of AMI, 39.6% of those with UA and just 25.8% of those with SA. Women were significantly older than men, had a higher BMI, and more often suffered from hypertension and diabetes. The duration of hospitalisation was the same in men and women if the reason for PCI was SA or UA, however, in case of AMI women were hospitalised significantly longer than men. In the univariate analysis gender had no influence on in-hospital mortality regardless of the reason for PCI treatment. Among the variables subjected to multivariate analysis female gender, age, BMI, diabetes, hypercholesterolaemia, indication for PCI, final TIMI flow in the target vessel and cardiogenic shock as a complication of AMI were shown to affect mortality. Significant effects on in-hospital mortality for women were exhibited only by cardiogenic shock. Among men, indication for PCI, age, diabetes and final TIMI flow in the target vessel also had a significant influence on in-hospital mortality.
Conclusions:
Stable angina is a reason for performing PCI more rarely in women than in men. Women with CAD are older than men and have more risk factors. The in-hospital mortality among patients treated with PCI because of SA is independent of gender. Cardiogenic shock appeared to be the only factor that influences in-hospital mortality in women. In the case of men such an influence is also observed for indication for PCI (AMI, UA or SA), diabetes and final TIMI flow in the target vessel.
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