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Sex Differences in Acute Bleeding and Vascular Complications Following Percutaneous Coronary Intervention Between
Hannah I Chaudry1, Jiyong Lee2, Shawn X Li3
1Cardiovascular Institute Brown University/Rhode Island Hospital, Providence, RI, United States of America.
Insights
While bleeding and vascular complications decreased for all patients undergoing percutaneous coronary intervention (PCI), women still experience higher bleeding rates than men. However, the gender gap in vascular complications has been eliminated.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Services Research
Background:
- Women undergoing percutaneous coronary intervention (PCI) face higher risks of bleeding and vascular complications compared to men.
- Modern PCI techniques aim to reduce bleeding, but their impact on the gender disparity in complications is not well-studied.
Purpose of the Study:
- To quantify and compare bleeding and vascular complication rates between men and women undergoing PCI over time.
- To assess the impact of evolving PCI strategies on the gender gap in post-procedural complications.
Main Methods:
- A retrospective analysis of 15,284 consecutive PCI cases from January 2003 to June 2016.
- Comparison of demographic, procedural, and in-hospital outcomes between men and women, analyzing trends over the study period.
Main Results:
- Rates of bleeding and vascular complications significantly decreased in both women (13.2% to 3%; 6.5% to 0.8%) and men (3.5% to 0.7%; 3.4% to 0.7%).
- Adoption of radial access and reduced use of GP IIb/IIIa inhibitors contributed to these decreases.
- The reduction in complication rates was more pronounced in women, narrowing the gender gap for vascular complications.
Conclusions:
- Percutaneous coronary intervention (PCI) complication rates declined between 2003 and 2016 for both sexes.
- Vascular complication rates became similar between men and women, eliminating the gender disparity.
- Despite overall reductions, women continue to experience higher rates of bleeding post-PCI compared to men.
Background:
Women undergoing percutaneous coronary intervention (PCI) are at higher risk for bleeding and vascular complications than men. Multiple approaches have been utilized to reduce bleeding in the modern era of PCI, including radial access, reduced GP IIb/IIIa inhibitor use, increased vascular closure device use, smaller sheath size and novel antithrombotic regimens. Nevertheless, few studies have assessed the impact of these techniques on the gap between men and women for such complications following PCI. We sought to quantify bleeding and vascular complications over time between men and women.
Methods:
We queried The Dartmouth Dynamic Registry for consecutive PCI's performed between January 2003 and June 2016. Demographic information, procedural characteristics, and in-hospital outcomes were collected and compared between men and women over the years.
Results:
We reviewed 15,284 PCI cases, of which 4384 (29%) were performed in women. Radial access increased from none in 2003 to nearly 40% in 2016. Use of GP IIb/IIIa and femoral access decreased substantially over the same time. Bleeding and vascular complication rates decreased significantly in women (13.2% to 3%; 6.5% to 0.8%, respectively) and men (3.5% to 0.7%, 3.4% to 0.7%, respectively). The overall bleeding and vascular complication rates decreased more for women than men, narrowing the gender gap.
Conclusions:
The incidence of bleeding and vascular complications fell between 2003 and 2016 in both men and women. Vascular complications have become less common over time, and based on our analysis, there was no longer any difference between the sexes for this outcome. Bleeding following PCI has decreased in both sexes over time; however, women continue to bleed more than men.
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