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Percutaneous transluminal coronary angioplasty in women compared with men
W S Weintraub1, N K Wenger, A S Kosinski
1Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Insights
Women experienced higher in-hospital mortality after angioplasty, but long-term survival and clinical outcomes were similar to men when adjusted for age and body size. This study highlights sex-based differences in coronary artery disease management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Coronary artery disease (CAD) is a leading cause of death in women, prompting increased research into sex-specific outcomes.
- Understanding disparities in cardiovascular disease treatment and outcomes between men and women is crucial for equitable healthcare.
Purpose of the Study:
- To compare in-hospital and long-term outcomes following percutaneous coronary intervention (PCI) in women versus men.
- To identify factors influencing outcomes in different genders after angioplasty.
Main Methods:
- A retrospective analysis of patients undergoing angioplasty, excluding those with prior revascularization or acute myocardial infarction.
- Standard angioplasty techniques were employed, with clinical data collected from a database and analyzed statistically.
Main Results:
- Women were older and had higher rates of hypertension, diabetes, and severe angina compared to men. Men had higher rates of prior myocardial infarction and multivessel disease.
- In-hospital mortality was higher in women (0.7% vs. 0.1%), but long-term survival at five years was similar (92% in women vs. 95% in men).
- Female gender was not an independent predictor of long-term survival after accounting for age and other clinical factors. No significant difference in freedom from myocardial infarction was observed between genders.
Conclusions:
- Despite higher initial mortality, women and men have comparable long-term survival and clinical outcomes after angioplasty when age and body habitus are considered.
- The study underscores the importance of considering demographic and clinical factors in evaluating angioplasty outcomes across genders.
Objectives:
This study compares in-hospital and long-term outcome after angioplasty in women and men.
Background:
The recognition that coronary artery disease is the most common cause of death in women has increased interest in outcome studies of coronary artery disease in women.
Methods:
Patients who had previous coronary revascularization and those who underwent angioplasty in the setting of acute myocardial infarction were excluded. Angioplasty was performed with standard methods. Clinical data were retrieved from a clinical data base and analyzed with standard statistical methods.
Results:
There were 2,845 women and 7,940 men. The women were older (62 +/- 11 vs. 57 +/- 10 years) and had more hypertension (54.5% vs. 40.1%), diabetes (19.3% vs. 11.7%), grade III to IV angina (71.5% vs. 58.4%) and congestive failure (4.3% vs. 2.1%) than men (all p < 0.0001). More men had a previous myocardial infarction (35.4% vs. 31.0%) and were taller and weighed more (all p < 0.0001). The men had lower ejection fractions and more multivessel disease (31.0% vs. 25.2%) (both p < 0.0001). In women there was a trend toward more Q wave myocardial infarctions (1.1% vs. 0.75%, p = 0.10), and hospital mortality was higher (0.7% vs. 0.1%, p < 0.0001). Angina at follow-up was more common in women 40.2% vs. 26.7%, p < 0.0001). The multivariate correlates of in-hospital death were short stature, reduced ejection fraction and multivessel disease, with trends for older age and female gender. Five-year survival was 95% in men and 92% in women (p = 0.0002). However, female gender was not a multivariate correlate of long-term survival and was accounted for by other characteristics, primarily age. The multivariate correlates of long-term survival were older age, congestive failure, reduced ejection fraction, multivessel disease, diabetes, hypertension and a trend for severe angina. No difference between women and men was noted in long-term freedom from myocardial infarction. There were more additional procedures in men than in women.
Conclusions:
Despite higher in-hospital mortality, long-term mortality and clinical outcome were similar in both genders when age and body habitus were accounted for.