Sex Differences in Outcomes Following Percutaneous Coronary Intervention According to Age
Kelly C Epps1, Elizabeth M Holper1, Faith Selzer1
1From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.); Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.); Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.); Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.); Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.); Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.); and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.).
Insights
Young women under 50 with coronary artery disease face higher risks of major adverse cardiovascular events after percutaneous coronary intervention (PCI). Further research is needed to understand these increased risks in young women.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Outcomes Research
Background:
- Coronary artery disease (CAD) in women under 50 is less common but may carry higher risks.
- Percutaneous coronary intervention (PCI) is a common treatment for CAD.
- Long-term outcomes data for young women undergoing PCI are limited.
Purpose of the Study:
- To assess the long-term cardiovascular outcomes of young women (<50 years) after PCI.
- To compare the risks of major adverse cardiovascular events (MACE) between young women, older women, and men.
- To identify potential disparities in treatment outcomes based on age and sex.
Main Methods:
- Analysis of the National Heart, Lung, and Blood Institute Dynamic Registry.
- Inclusion of 10,963 patients who underwent PCI, with a 5-year follow-up period.
- Evaluation of cardiovascular-related outcomes, including death, myocardial infarction, coronary artery bypass graft surgery, and repeat PCI.
Main Results:
- Young women (<50 years) had a higher cumulative rate of MACE at 1 year (27.8% vs. 19.9%) compared to older women and men.
- Higher rates of repeat revascularization (coronary artery bypass graft surgery and repeat PCI) were observed in young women.
- At 5 years, young women continued to show increased risk for repeat procedures, while outcomes were similar between older women and men.
Conclusions:
- Young women with CAD experience a higher risk of target vessel and target lesion failure after PCI, even with less severe initial disease.
- The underlying causes for increased adverse events in young women require further investigation.
- Sex and age are critical factors influencing long-term outcomes after PCI for coronary artery disease.
Background:
Women <50 years of age with coronary artery disease may represent a group at higher risk for recurrent ischemic events after percutaneous coronary intervention (PCI); however, no long-term, multicenter outcomes assessment exists in this population.
Methods And Results:
Using the National Heart, Lung, and Blood Institute Dynamic Registry, we evaluated the association of sex and age on cardiovascular-related outcomes in 10,963 patients (3797 women, 394 <50 years) undergoing PCI and followed for 5 years. Death, myocardial infarction, coronary artery bypass graft surgery, and repeat PCI were primary outcomes comprising major adverse cardiovascular events. Although procedural success rates were similar by sex, the cumulative rate of major adverse cardiovascular events at 1 year was higher in young women (27.8 versus 19.9%; P=0.003), driven largely by higher rates of repeat revascularizations for target vessel or target lesion failure (coronary artery bypass graft surgery: 8.9% versus 3.9%, P<0.001, adjusted hazard ratio 2.4, 95% confidence interval 1.5-4.0; PCI: 19.0% versus 13.0%, P=0.005, adjusted hazard ratio 1.6, 95% confidence interval 1.2-2.2). At 5 years, young women remained at higher risk for repeat procedures (coronary artery bypass graft surgery: 10.7% versus 6.8%, P=0.04, adjusted hazard ratio 1.71, 95% confidence interval 1.01-2.88; repeat PCI [target vessel]: 19.7% versus 11.8%, P=0.002, adjusted hazard ratio 1.8, 95% confidence interval 1.24-2.82). Compared with older women, younger women remained at increased risk of major adverse cardiovascular events, whereas all outcome rates were similar in older women and men.
Conclusions:
Young women, despite having less severe angiographic coronary artery disease, have an increased risk of target vessel and target lesion failure. The causes of this difference deserve further investigation.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005677.
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