CCI: Women fare worse than men post-PCI

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Recent, emerging studies have outlined gender disparities within PCI outcomes. A study published Nov. 1 in Catheterization and Cardiovascular Interventions confirmed these findings, after researchers reported that women undergoing PCI have a greater incidence of comorbidities and adverse events when compared with men.

“Female gender is considered to be a risk factor for unfavorable outcomes following coronary revascularization,” Jason C. Kovacic, MD, PhD, from the Mount Sinai Medical Center in New York City, and colleagues wrote. “With the advent of PCI, one of the first publications pertaining to gender-based outcomes reported that women have lower procedural success and higher long-term mortality rates after PCI.”

To better understand the possibility of gender disparities post-PCI, Kovacic and colleagues identified 13,752 patients who underwent a PCI procedure between April 2003 and April 2009 and assessed gender-based outcome disparities post-procedure. Of the 13,752 patients, 34.6 percent were women, and compared to men, women were older. Additionally, more women had hypertension and were diabetic compared with men and women also had higher HDL-cholesterol levels.

During the study, bare-metal stents (BMS) were used in 19.7 percent of females compared with 18.5 percent of males. Likewise, first generation drug-eluting stents (DES) were used in 67.3 percent of females compared with 68.1 percent of males; second generation DES were used in 12.9 percent of females versus 13.4 percent of males.

Thirty-days post-PCI, women had higher rates of death compared to men, 1.3 percent vs. 0.8 percent, respectively. At three years the rate of death was 10.4 percent for females and 8.4 percent in males.

Additionally, the researchers analyzed the predictors of death one-year post-PCI and found that female gender was predictive of all-cause death at one-year post-PCI. Additionally, females had more comorbidities and a worse overall CV risk profile compared to men.

“Gender-based inequalities in numerous cardiovascular risk factors and comorbidities are potentially thought to account for the worse unadjusted outcomes seen in women after PCI, including smaller body size, smaller arterial diameter, hormonal differences, atypical and/or delayed presentation, decreased sensitivity and specificity of noninvasive stress testing, abnormal coronary artery vasoreactivity ("endothelial dysfunction"), microvascular dysfunction, differences in plaque morphology, and suboptimal use of adjunctive medical therapies,” Kovacic et al wrote.

"In this study, female patients presenting for PCI exhibited significantly more comorbidities and adverse prognostic factors than males," the authors concluded. "Correspondingly, in unadjusted analyses females suffered significantly worse outcomes after PCI than their male counterparts."

The authors noted that a limitation of the study was the fact that the trial was neither blinded nor randomized.