Mortality Differences Between Men and Women After Percutaneous Coronary Interventions

Singh, Mandeep; Rihal, Charanjit S.; Gersh, Bernard J.; Roger, Véronique L.; Bell, Malcolm R.; Lennon, Ryan J.; Lerman, Amir; Holmes, David R.

doi:10.1016/j.jacc.2008.01.066

Cited by 131 publications

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References 30 publications

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“…13 For the present study, we included only patients from the Rochester area (Olmsted County) who had undergone PCI between January 1, 1994, and June 30, 2008, and and follow-up data were considered only for the earliest PCI. Because the Mayo Clinic is the only location in Olmsted County that performed PCI during the study period, the study sample very closely approximates a community-based sample of people undergoing PCI in Olmsted County.…”

Section: Methodsmentioning

confidence: 99%

“…13 For the present study, we included only patients from the Rochester area (Olmsted County) who had undergone PCI between January 1, 1994, and June 30, 2008, and were discharged alive. If patients had Ͼ1 PCI, their CR and follow-up data were considered only for the earliest PCI.…”

Section: Methodsmentioning

confidence: 99%

“…Secondary end points were cardiac death, MI, and coronary revascularization (PCI or coronary artery bypass graft surgery [CABG]), which were ascertained by a review of patient medical records at each subsequent hospitalization. 13,16 Death certificates were used to classify cardiac and noncardiac causes of death. …”

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Impact of Cardiac Rehabilitation on Mortality and Cardiovascular Events After Percutaneous Coronary Intervention in the Community

et al. 2011

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Background-Although numerous studies have reported that cardiac rehabilitation (CR) is associated with reduced mortality after myocardial infarction, less is known about its association with mortality after percutaneous coronary intervention. Methods and Results-We performed a retrospective analysis of data from a prospectively collected registry of 2395 consecutive patients who underwent percutaneous coronary intervention in Olmsted County, Minnesota, from 1994 to 2008. The association of CR with all-cause mortality, cardiac mortality, myocardial infarction, or revascularization was assessed with 3 statistical techniques: propensity score-matched analysis (nϭ1438), propensity score stratification (nϭ2351), and regression adjustment with propensity score in a 3-month landmark analysis (nϭ2009). During a median follow-up of 6.3 years, 503 deaths (199 cardiac), 394 myocardial infarctions, and 755 revascularization procedures occurred in the study subjects. Participation in CR, noted in 40% (964 of 2395) of the cohort, was associated with a significant decrease in all-cause mortality by all 3 statistical techniques (hazard ratio, 0.53 to 0.55; PϽ0.001). A trend toward decreased cardiac mortality was also observed in CR participants; however, no effect was observed for subsequent myocardial infarction or revascularization. The association between CR participation and reduced mortality rates was similar for men and women, for older and younger patients, and for patients undergoing elective or nonelective percutaneous coronary intervention. Conclusion-We found that CR participation after percutaneous coronary intervention was associated with a significant reduction in mortality rates. These findings add support to published clinical practice guidelines, performance measures, and insurance coverage policies that recommend CR for patients after percutaneous coronary intervention. (Circulation. 2011;123:2344-2352.)Key Words: angioplasty Ⅲ cardiac rehabilitation Ⅲ exercise Ⅲ mortality Ⅲ prevention Ⅲ stents C ardiac rehabilitation (CR) is associated with a 20% to 30% reduction in mortality in persons with coronary artery disease, particularly after myocardial infarction (MI). [1][2][3] This benefit is thought to be mediated by several factors, including the physiological benefits of exercise training, 4,5 psychological benefits of group support and counseling, 6 improved adherence to preventive therapies, 7 and improved control of cardiovascular risk factors. 4,8 Unfortunately, even with this strong evidence, only Ϸ25% of eligible patients in the United States participate in CR. 9 Clinical Perspective on p 2352More than 1 million percutaneous coronary intervention (PCI) procedures are performed in the United States annually. 10 However, very little direct evidence has been published regarding CR participation rates and the impact of CR on mortality after PCI. Even with the paucity of data, several national guidelines have recommended CR after PCI, 11 and in 2006, the Centers for Medicare and Medicaid Services included PCI ...

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Impact of Cardiac Rehabilitation on Mortality and Cardiovascular Events After Percutaneous Coronary Intervention in the Community

et al. 2011

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“…Previous studies reported stroke rates of 0.1-0.4% [1][2][3][4][5][6][7][8][9]. Catheterization-related acute stroke is associated with high in-hospital mortality and prevalence of overall major complications [5,10,11].…”

Section: Introductionmentioning

confidence: 99%

Hypercholesterolemia as a Risk Factor for Catheterization- Related Cerebral Infarction — A Literature Review and a Summary of Cases

Morita¹,

Kato²,

Inoko³

2015

Hypercholesterolemia

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“…3,4 Moreover, for those women treated with PCI, unadjusted mortality ( Figure 2) and (vascular and bleeding) complication rates ( Figure 3) remain significantly higher than in men. 5,6 Whether these sex differences are explained by pathophysiology by impaired access to guideline-recommended therapies, by biology or bias, by lack of a robust evidence base in women, or by the artificial comparison between women and men as their control group, continues to be actively debated. Certainly, the seemingly paradoxical findings of a higher prevalence of risk factors, more severe angina symptoms but a similar (or lesser) extent of epicardial coronary disease, and of a higher prevalence of congestive heart failure despite better of left ventricular systolic function in women compared with men undergoing coronary revascularization, are likely based on underlying sex differences in vascular and myocardial physiology, structure, and function.…”

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Coronary Intervention in 2009

Jacobs

2009

Circ: Cardiovascular Interventions

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ardiovascular disease remains the leading cause of death in the United States in both women and men, and each year for more than 2 decades, more women than men have died ( Figure 1). In 2006, 41.3 million women (34.9%) and 38.7 million men (37.6%) were living with cardiovascular disease, reflecting mortality in 454.6 thousand women and 409.9 thousand men in 2005, with coronary heart disease responsible for 1 of every 5 deaths overall. In fact, the lifetime risk of developing coronary heart disease after age 40 is 49% in men and 32% in women. Furthermore, it is estimated that in 2009, cardiovascular disease and stroke will cost the nation $475.3 billion. 1 Despite these sobering statistics, marked disparities in cardiovascular health and care, and specifically in the delivery and outcomes of coronary revascularization therapy, persist between women and men. Of the 1.3 million percutaneous coronary intervention (PCI) procedures performed in 2006, only 35% were performed in women, 1 despite the known benefits of this treatment, particularly in high-risk women with acute coronary syndromes (ACS) 2 and STsegment elevation myocardial infarction (STEMI). 3,4 Moreover, for those women treated with PCI, unadjusted mortality ( Figure 2) and (vascular and bleeding) complication rates ( Figure 3) remain significantly higher than in men. 5,6 Whether these sex differences are explained by pathophysiology by impaired access to guideline-recommended therapies, by biology or bias, by lack of a robust evidence base in women, or by the artificial comparison between women and men as their control group, continues to be actively debated. Certainly, the seemingly paradoxical findings of a higher prevalence of risk factors, more severe angina symptoms but a similar (or lesser) extent of epicardial coronary disease, and of a higher prevalence of congestive heart failure despite better of left ventricular systolic function in women compared with men undergoing coronary revascularization, are likely based on underlying sex differences in vascular and myocardial physiology, structure, and function. 7 Given the increasing awareness by patients, the public, and healthcare providers of the prevalence and impact of coronary heart disease in women, it is timely to review the current status and issues concerning coronary intervention in women, 8,9 focusing on biology and pathophysiology, access to care, and outcomes across the spectrum of coronary disease acuity. A greater understanding of the basis for the ongoing sex disparities in patients undergoing PCI may serve as a platform to improve the overall quality of cardiovascular health care in women. Sex-Related Differences in the Biology and Pathophysiology of Cardiovascular DiseaseWhether the increased mortality after PCI and MI in women in comparison with men can be explained by factors inherent to the female sex is unclear. However, several vascular abnormalities more prevalent in women including vasospastic disorders, Raynaud phenomenon, various forms of vasculitis, and migraine headaches ...

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Mortality Differences Between Men and Women After Percutaneous Coronary Interventions

Abstract: The 30-day mortality after PCI in men and women has decreased in the past 25 years. After accounting for baseline risks, no differences in short-term or long-term mortality were observed between men and women.

Cited by 131 publications

References 30 publications

Impact of Cardiac Rehabilitation on Mortality and Cardiovascular Events After Percutaneous Coronary Intervention in the Community

Impact of Cardiac Rehabilitation on Mortality and Cardiovascular Events After Percutaneous Coronary Intervention in the Community

Hypercholesterolemia as a Risk Factor for Catheterization- Related Cerebral Infarction — A Literature Review and a Summary of Cases

Coronary Intervention in 2009

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