Sex differences in mortality after percutaneous coronary intervention: a contemporary nationwide registry and
Kittipong Pinyosamosorn1, Songsak Kiatchoosakun2, Sasiporn Sitthisorn3
1Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Maharat Nakhonratchasima Hospital, Nakhon Ratchasima, Thailand.
Insights
Women face higher in-hospital mortality after percutaneous coronary intervention (PCI). Specific conditions like chronic kidney disease and cardiogenic shock disproportionately increase mortality risk in women, highlighting a need for tailored care.
Area of Science:
- Cardiology
- Interventional Cardiology
- Sex-Based Medicine
Background:
- Coronary artery disease (CAD) is a leading cause of death globally.
- Women experience higher mortality rates post-percutaneous coronary intervention (PCI) compared to men.
- Existing data on sex-specific risk factors and mortality following PCI is limited.
Purpose of the Study:
- To evaluate in-hospital mortality rates after PCI.
- To identify and analyze sex-specific risk factors associated with PCI outcomes.
- To investigate disparities in mortality between men and women undergoing PCI.
Main Methods:
- Analysis of a national PCI registry (19,701 patients).
- Stratification of the patient cohort by sex.
- Multivariable regression models to assess risk factors for in-hospital mortality.
Main Results:
- Women had a higher in-hospital mortality rate (3.5%) than men (2.3%).
- Chronic kidney disease (CKD), cerebrovascular disease, and cardiogenic shock (CS) significantly increased mortality risk exclusively in women.
- Factors like emergency PCI, urgent PCI, and new dialysis requirement showed a more pronounced association with mortality in women compared to men.
Conclusions:
- Women undergoing PCI exhibit significantly higher in-hospital and one-year mortality rates.
- Stroke history, CS, and CKD are key mortality risk factors in women post-PCI.
- Enhanced awareness and tailored peri-procedure care are crucial for improving outcomes in women.
Background:
Despite advancements in medical care, coronary artery disease (CAD) remains a leading cause of death. Previous studies have indicated a higher mortality rate for women compared to men following percutaneous coronary intervention (PCI). While both sexes share common risk factors, the magnitude of their impact may differ, and specific sex-related factors contribute to observed disparities. Although attempts have been made to reduce this gap, data concerning medical care and risk factors related to mortality remain limited. This study aims to assess the in-hospital mortality rate following PCI and to investigate sex-specific differences in associated risk factors.
Methods:
We utilized a comprehensive national PCI registry comprising 19,701 patients. The patient cohort was stratified by sex. In-hospital mortality rates were reported, and risk factors related to mortality were analyzed using multivariable models.
Results:
Women exhibited a higher in-hospital mortality rate (3.5%) compared to men (2.3%). They were also more significantly affected by specific risk factors that increased mortality exclusively in women: chronic kidney disease (CKD) [odds ratio (OR) 2.73, 95% confidence interval (CI): 1.90-3.93, P<0.001], cerebrovascular disease (OR 2.43, 95% CI: 1.43-4.12, P=0.001), and cardiogenic shock (CS) at the time of PCI (OR 5.6, 95% CI: 3.85-8.15, P<0.001). Furthermore, several factors demonstrated a greater association with mortality in women compared to men. Women undergoing emergency PCI exhibited a higher odds ratio (OR 14.01, 95% CI: 8.03-24.43, P<0.001) than men (OR 3.77, 95% CI: 2.19-6.50, P<0.001). Similar trends were observed for urgent PCI (OR 5.58, 95% CI: 3.08-10.09, P<0.001 vs. OR 2.74, 95% CI: 1.64-4.58, P<0.001) and new required dialysis (OR 7.10, 95% CI: 2.84-17.77, P<0.001 vs. OR 3.28, 95% CI: 1.83-5.86, P<0.001).
Conclusions:
Women undergoing PCI had significantly higher in-hospital and one-year mortality rates than men. Key risk factors for increased mortality in women include a history of stroke, CS, and CKD. While emergency PCI, dialysis initiation, arrhythmias, and procedure failure affect both sexes, their impact was more pronounced in women. Improving prognosis requires increased attention to women's specific needs and enhanced awareness of appropriate peri-procedure care.
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