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Sex Differences in 1-Year Outcomes After Percutaneous Coronary Intervention in the Veterans Health Administration
Melissa M Farmer1, Maggie A Stanislawski2, Mary E Plomondon2
11 VA HSR&D Center for the Study of Healthcare Innovation , Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California.
Insights
This study found that women and men Veterans had similar outcomes after percutaneous coronary intervention (PCI), including lower rates of rehospitalization for myocardial infarction (MI) and mortality. These findings highlight comparable results in a population with significant comorbidities.
Area of Science:
- Cardiology
- Health Services Research
- Sex Differences in Medicine
Background:
- Percutaneous coronary intervention (PCI) has improved outcomes for obstructive coronary artery disease.
- Evidence on sex-based outcome disparities after PCI is inconsistent.
- Investigating sex differences in major adverse cardiac outcomes post-PCI in Veterans is crucial.
Purpose of the Study:
- To examine sex-based differences in 1-year major adverse cardiac outcomes.
- To compare outcomes for women and men Veterans undergoing PCI.
- To analyze rehospitalization for myocardial infarction (MI), all-cause mortality, and major adverse cardiovascular events (MACE) by sex.
Main Methods:
- Utilized data from 64,757 Veterans (1,040 women) undergoing PCI at VA hospitals (2007-2013).
- Employed Cox proportional hazards models to compare 1-year postprocedural outcomes.
- Assessed outcomes including MI rehospitalization, all-cause mortality, and MACE.
Main Results:
- Women Veterans were younger, more likely to be black, obese, and have depression.
- No significant sex differences were observed in 1-year rehospitalization for MI (2.1% vs 2.5%), mortality (3.5% vs 4.9%), or MACE (5.4% vs 6.9%).
- Cox models confirmed no significant sex differences in any outcome.
Conclusions:
- Women and men Veterans experienced comparable 1-year post-PCI outcomes despite differing clinical risk factors.
- These findings indicate similar effectiveness of PCI for both sexes in a high-comorbidity Veteran population.
- PCI outcomes are equitable across sexes within the VA system.
Background:
Advancements in percutaneous coronary intervention (PCI) for treating obstructive coronary artery disease have reduced major adverse events, including mortality. Yet, evidence as to whether women and men experience similar outcomes is mixed. The objective was to examine sex differences in 1-year major adverse cardiac outcomes for the national population of patients undergoing PCI at Veterans Health Administration (VA) cardiac catheterization laboratories.
Methods:
All Veterans undergoing PCI at VA hospitals between October 1, 2007 and September 30, 2013 (N = 64,757; Women = 1,040) were included. Cox proportional hazards models compared 1-year postprocedural outcomes [rehospitalization for myocardial infarction (MI), all-cause mortality, and major adverse cardiovascular events (MACE)] by sex.
Results:
Women Veterans undergoing PCI were more likely to be younger, black, obese, and have chronic depression and less likely to have common cardiovascular risk factors and to have had prior cardiac events than Veteran men. One-year rates for women versus men were 2.1% and 2.5% for rehospitalization (p-value = 0.57); 3.5% and 4.9% for mortality (p-value = 0.14), and 5.4% and 6.9% for MACE (p-value = 0.18). There were no significant sex differences in any of the outcomes in Cox proportional hazards models.
Conclusions:
Despite differences in clinical risk factors at the time of PCI, women and men Veterans treated at VA cardiac catheterization laboratories experienced comparable 1-year rehospitalization for MI, mortality, and MACE post-PCI. These results demonstrated similar 1-year post-PCI outcomes for men and women in a national population of patients who have more comorbidities and mental health issues than the general population.
