Women at greater risk of adverse outcomes following PCI

Women are at an increased risk of adverse events following percutaneous coronary intervention (PCI), according to new findings published in the Journal of the American College of Cardiology.

“Advances in PCI, including the introduction of drug-eluting stents (DES), have substantially improved long-term prognosis in patients with obstructive coronary artery disease (CAD),” wrote lead author Ioanna Kosmidou, MD, PhD, Columbia University Medical Center in New York City, and colleagues. “Nevertheless, despite some evidence that utilization of DES has predominantly benefited women, most studies have yielded conflicting results on long-term sex-related outcomes following PCI, likely due to small sample sizes, lack of randomization, and use of outdated technologies.”

Kosmidou et al. explored data from 21 PCI trials, focusing on cardiovascular outcomes five years following the procedure. The study included more than 32,000 patients who underwent PCI for obstructive CAD from 2000 to 2013, and 27.8% of the patients were women. Hypertension and diabetes were more common in women, but a history of surgical or percutaneous revascularization were more common in men.

Overall, five years following PCI, women had higher unadjusted rates of major adverse cardiac events (MACE) (18.9%), all-cause death (10.4%), cardiac death (4.9%) and ischemia-driven target lesion revascularization (ID-TLR) (10.9%) than men (17.7%, 8.7%, 4% and 10.2%, respectively). The differences were enough to make being a woman an independent predictor of MACE and ID-TLR—but not all-cause death or cardiac death.

“Importantly, in the present study, event rates were adjusted not only for well-established clinical risk factors that frequently vary between men and women, but also for core laboratory–assessed angiographic characteristics that are typically not considered in most meta-analyses or registry-based studies,” the authors wrote. “Even after accounting for these differences, the 5-year ID-TLR and MACE rates were higher in women than men.”

The researchers did provide some possible explanations for women experiencing a higher MACE rate.  For example, younger age was associated with a greater risk of adverse outcomes in women than in men. Also, the team added, “the low inclusion rate of women in randomized trials … has resulted in device-based techniques being optimized for men.”

“Further studies are warranted to address whether sex-specific pharmacological therapies or procedural approaches may improve the long-term prognosis of women undergoing PCI,” Kosmidou and colleagues concluded.