CRT: Younger women who undergo PCI at greater risk than younger men

WASHINGTON, D.C.—Special care should be directed to female patients presenting to the cath lab with symptomatic premature coronary artery disease (CAD), as young females have high rates of comorbidities and their long-term procedural outcomes are poor compared with younger males.

These were the results of a scientific poster at the Feb. 23-26 Cardiovascular Research Technologies (CRT) annual meeting. 

There is a “paucity of data” on the risk variables, clinical presentation and long-term outcomes in patients presenting with symptomatic premature CAD, according to Lakshmana K. Pendyala, MD, of MedStar/Washington Hospital Center in Washington, D.C., and colleagues. Thus, they conducted this study to understand the gender differences in risk factors for premature atherosclerosis and also to evaluate the determinants of adverse outcomes after contemporary PCI in young patients.

The researchers included 167 consecutive patients, aged 40 years or younger, who were treated with PCI with a stent at Washington Hospital Center from January 2004 to May 2011. They analyzed baseline characteristics, clinical presentation, inhospital and long-term outcomes. 

In this young group of patients (age 37), Pendyala et al reported that females have higher prevalence of diabetes mellitus (48 vs. 23 percent), insulin-dependent diabetes mellitus (30 vs. 7 percent), congestive heart failure (14 vs. 2 percent), chronic renal insufficiency (15 vs. 4 percent) and lower baseline hemocrit (35 vs. 42), compared with males.

Also, African-Americans constituted 52 percent of the female patient population compared with 25 percent seen in males. 

The inhospital mortality was 2.4 percent, which was similar between the two groups except the higher rate of blood transfusions in women, according to the authors.

At one year, the target lesion revascularization rates were higher in women (22 vs. 10 percent). The target vessel revascularization rates at one year also were higher in women (28 vs. 13 percent). 

Death at one year followed the same trend (9 vs. 3.4 percent).

Also, the researchers said that baseline hemocrit and the number of lesions treated were independent correlates of major adverse coronary  events at one year. 

Based on these findings, Pendyala et al concluded that “special care” was warranted for younger female patients who present to the cath lab for PCI.