Gender-based outcomes of coronary bifurcation stenting: A report from the National Readmission Database
Mohammed Osman1, Yasir Abdul Ghaffar1, Khansa Osman2
1Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
Insights
Women experience worse outcomes after percutaneous coronary interventions (PCI) for coronary bifurcation lesions (CBLs). This study found higher major adverse events and readmission rates in women compared to men, primarily due to increased bleeding and transfusion needs.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Limited data exists on outcomes for women undergoing percutaneous coronary interventions (PCI) for coronary bifurcation lesions (CBLs).
- Understanding sex-based differences in PCI for CBLs is crucial for improving patient care.
Purpose of the Study:
- To investigate and compare in-hospital outcomes between women and men after PCI for CBLs in the setting of acute coronary syndrome (ACS).
- To identify potential disparities in adverse events, resource utilization, and readmission rates.
Main Methods:
- Retrospective analysis of the United States National Readmission Database (October 2015 - December 2017).
- Inclusion of patients who underwent PCI for CBLs during acute coronary syndrome (ACS).
- 1:1 propensity score matching used to compare outcomes between women and men.
Main Results:
- Women had significantly higher in-hospital major adverse events (MAEs) (7% vs. 5.2%) compared to men.
- Higher rates of major bleeding (1.8% vs. 0.8%), post-procedural bleeding (6.1% vs. 3.4%), and blood transfusions (6.4% vs. 4.2%) were observed in women.
- Women experienced longer hospital stays and a higher 30-day readmission rate (14.2% vs. 11.5%) than men.
Conclusions:
- Women undergoing PCI for CBLs in the context of ACS face higher MAEs and 30-day readmission rates compared to men.
- Increased post-procedural bleeding and the need for blood transfusions significantly contributed to the higher MAEs in women.
- These findings highlight the need for sex-specific considerations in the management of women with coronary artery disease involving bifurcation lesions.
Background:
There is a paucity of data focusing on women's outcomes after percutaneous coronary interventions (PCI) for coronary bifurcation lesions (CBLs).
Methods:
Patients who received PCI for CBLs in the context of acute coronary syndrome (ACS) during the period of 01 October 2015- 31 December 2017, were identified from the United States National Readmission Database. The primary endpoint of this study was in-hospital major adverse events (MAEs). The secondary endpoints were in-hospital mortality, vascular complications, major bleeding, post-procedural bleeding, need for blood transfusion, severe disability surrogates (non-home discharge and need for mechanical ventilation), resources utilization surrogates (length of stay and cost of hospitalization), and 30-day readmission rate. A 1:1 propensity score matching was used to compare the outcomes between women and men.
Results:
A total of 25,050 (women = 7,480; men = 17,570) patients were included in the current analysis. After propensity score matching, women had higher in-hospital MAEs (7 vs 5.2%, p < .01), major bleeding (1.8 vs 0.8%, p < .01), post-procedural bleeding (6.1 vs 3.4%, p < .01), need for blood transfusion (6.4 vs 4.2%, p < .01), non-home discharges (10.2 vs 7.1%; p < .01), longer length of hospital stay (3 days [IQR 2-6] vs. 3 days [IQR 2-5], p < .01) and higher 30-day readmission rate compared to men (14.2 vs. 11.5%, p < .01).
Conclusions:
Among all-comers who received PCI for CBLs in the context of ACS, women suffered higher MAEs and 30-day readmission rates compared to their men' counterparts. The higher MAEs in the women were mainly driven by higher postprocedural bleeding rates and the need for blood transfusion.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Mitral Stenosis III: Medical Management
01:26Acute Coronary Syndrome V: Nursing Management