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Impact of sex on outcomes associated with polyvascular disease in patients after PCI
Birgit Vogel1, Stephanie Jou1, Samantha Sartori1
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
Insights
Polyvascular disease (PVD) increases major adverse cardiovascular events (MACE) risk after percutaneous coronary intervention (PCI) similarly in both women and men. Maximizing secondary prevention is crucial for all patients with PVD.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Biology
Background:
- Atherosclerosis affecting multiple arterial beds (polyvascular disease, PVD) is linked to higher risks of major adverse cardiovascular events (MACE).
- The differential impact of PVD on post-percutaneous coronary intervention (PCI) MACE risk between sexes remains incompletely understood.
Purpose of the Study:
- To investigate whether the risk of MACE following PCI in patients with PVD differs between women and men.
- To compare the relative risk of MACE associated with PVD versus coronary artery disease (CAD) alone, stratified by sex.
Main Methods:
- Analysis of 18,721 patients undergoing PCI between 2012-2019, with PVD defined as prior peripheral artery and/or cerebrovascular disease.
- Primary endpoint was MACE (all-cause death, myocardial infarction, or stroke) at 1 year post-PCI.
- Multivariate Cox regression and interaction testing were employed to assess sex-based differences in MACE risk associated with PVD.
Main Results:
- Women comprised 29.2% of the cohort and had a higher prevalence of PVD (21.7%) compared to men (16.1%).
- Patients with PVD were older and had more comorbidities and risk factors.
- Women with PVD exhibited the highest MACE rate (10.0%), yet adjusted analyses showed similar relative MACE risk increases from PVD in both women (aHR 1.54) and men (aHR 1.31).
Conclusions:
- Polyvascular disease confers a similar excess risk of MACE after PCI in both women and men.
- Aggressive secondary prevention strategies are essential for all patients with PVD, irrespective of sex, to mitigate cardiovascular event risk.
Background:
Atherosclerosis in more than 1 vs. 1 arterial bed is associated with increased risk for major adverse cardiovascular events (MACE). This study aimed to determine whether the risk of post percutaneous coronary intervention (PCI) MACE associated with polyvascular disease (PVD) differs by sex.
Methods:
We analyzed 18,721 patients undergoing PCI at a tertiary-care center between 2012 and 2019. Polyvascular disease was defined as history of peripheral artery and/or cerebrovascular disease. The primary endpoint was MACE, a composite of all-cause death, myocardial infarction, or stroke at 1 year. Multivariate Cox regression was used to adjust for differences in baseline risk between patients with PVD vs. coronary artery disease (CAD) alone and interaction testing was used to assess risk modification by sex.
Results:
Women represented 29.2% (N = 5,467) of the cohort and were more likely to have PVD than men (21.7% vs. 16.1%; P < .001). Among both sexes, patients with PVD were older with higher prevalence of comorbidities and cardiovascular risk factors. Women with PVD had the highest MACE rate (10.0%), followed by men with PVD (7.2%), women with CAD alone (5.0%), and men with CAD alone (3.6%). Adjusted analyses revealed similar relative MACE risk associated with PVD vs. CAD alone in women and men (adjusted hazard ratio [aHR] 1.54, 95% confidence interval [CI] 1.20-1.99; P < .001 and aHR 1.31, 95% CI 1.06-1.62; P = .014, respectively; p-interaction = 0.460).
Conclusion:
Women and men derive similar excess risk of MACE from PVD after PCI. The heightened risk associated with PVD needs to be addressed with maximized use of secondary prevention in both sexes.
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