Treatment Effect of Percutaneous Coronary Intervention in Men Versus Women With ST-Segment-Elevation Myocardial
Samian Sulaiman1, Akram Kawsara1, Mohamed O Mohamed2
1Division of Cardiology West Virginia University Morgantown WV.
Insights
Primary percutaneous coronary intervention (pPCI) offers similar mortality benefits for both men and women with ST-segment-elevation myocardial infarction. Despite comparable outcomes, women receive pPCI less often than men in current US practice.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Women experience worse outcomes with primary percutaneous coronary intervention (pPCI) compared to men, potentially due to risk aversion.
- The comparative mortality benefit of pPCI between sexes remains under-explored.
Purpose of the Study:
- To investigate whether pPCI provides a comparable mortality benefit for men and women with ST-segment-elevation myocardial infarction (STEMI).
- To analyze sex-based differences in pPCI utilization, outcomes, and associated costs.
Main Methods:
- Analysis of the National Inpatient Sample (2016-2018) for STEMI admissions.
- Utilized propensity-score matching to assess the average treatment effects of pPCI on mortality, complications, length of stay, and cost.
- Conducted sensitivity analyses using logit models and marginal effect calculations.
Main Results:
- A total of 413,500 hospitalizations were analyzed, with women comprising 30.7%. Women presented with more comorbidities but were less likely to undergo pPCI (74.0% vs. 82.0%).
- pPCI demonstrated comparable average treatment effects on in-hospital mortality for both women (-9.5%) and men (-8.4%) (P interaction=0.16).
- Treatment effects on major complications were similar, except for acute stroke. The proportional cost increase associated with pPCI was higher in women.
Conclusions:
- pPCI significantly reduces in-hospital mortality in STEMI patients, with comparable benefits observed in both men and women.
- Despite similar mortality benefits, women continue to have lower rates of pPCI utilization in contemporary US healthcare settings.
Abstract:
Background Women are less likely to receive primary percutaneous coronary intervention (pPCI) than men. A potential reason is risk aversion because of the worse outcomes with pPCI among women. However, whether pPCI is associated with a comparable mortality benefit in men and women remains unknown. Methods and Results We selected patients admitted with a principal diagnosis of ST-segment-elevation myocardial infarction in the National Inpatient Sample (2016-2018). We used propensity-score matching to calculate average treatment effects of pPCI for in-hospital mortality, major complications, length of stay, and cost. As a sensitivity analysis, we used logit models followed by a marginal command to calculate the average marginal effect. We included 413 500 weighted hospitalizations (30.7% women, 69.3% men). Women had more comorbidities except smoking and prior sternotomy. Compared with men, women were less likely to undergo angiography (81.0% versus 87.0%; adjusted odds ratio [OR], 0.77; 95% CI, 0.74-0.81; P<0.001) or pPCI (74.0% versus 82.0%; adjusted OR, 0.76; 95% CI, 0.73-0.79; P<0.001). There were no significant differences in average treatment effects of pPCI on mortality between men (-8.4% [-9.3% to -7.6%], P<0.001), and women (-9.5% [-10.8% to -8.3%], P<0.001) (P interaction=0.16). This persisted in age-stratified analyses (≥85, 65-84, 45-64, <45 years) and sensitivity analysis, excluding emergent admissions. The average treatment effects of pPCI on major complications were comparable except for acute stroke, leaving against medical advice, and palliative encounter. There were no differences in the average treatment effects of pPCI on length of stay, but the proportional increase in cost with pPCI was higher in women. Conclusions pPCI results in a comparable reduction in in-hospital mortality in men and women. Nonetheless, risk-adjusted rates of pPCI remain lower in women in contemporary US practice.
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