Sex Differences in Outcomes Following Percutaneous Coronary Intervention According to Age

Abstract

Background Women <50 years of age with coronary artery disease (CAD) may represent a group at higher risk for recurrent ischemic events following percutaneous coronary intervention (PCI); however, no long-term, multi-center outcomes assessment exists in this population. Methods and Results Using the NHLBI Dynamic Registry we evaluated the association of sex and age on cardiovascular-related outcomes in10,963 patients (3,797 women, 394 <50 years) undergoing PCI and followed for 5 years. Death, myocardial infarction (MI), coronary artery bypass graft surgery (CABG), and repeat PCI were primary outcomes comprising major adverse cardiovascular events (MACE). While procedural success rates were similar by sex, the cumulative rate of MACE at 1 year was higher in young women (27.8 vs. 19.9%, p=0.003) driven largely by higher rates of repeat revascularizations for target vessel or target lesion failure (CABG: 8.9% vs. 3.9%, p<0.001, adjusted hazard ratio [aHR] 2.4, 95% CI 1.5-4.0; PCI: 19.0% vs. 13.0%, p=0.005, aHR 1.6, 95% CI 1.2-2.2). At 5 years, young women remained at higher risk for repeat procedures (CABG: 10.7% vs. 6.8%, p=0.04, aHR 1.71, 95% CI 1.01-2.88; repeat PCI [target vessel]: 19.7% vs. 11.8%, p=0.002, aHR 1.8, 95% CI 1.24-2.82). Compared to older women, younger women remained at increased risk of MACE, while all outcome rates were similar in older women and men. Conclusions Young women, despite having less severe angiographic CAD have an increased risk of target vessel and target lesion failure. The causes of this difference deserve further investigation. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005677.

Comparison of In-hospital Outcomes of Percutaneous Coronary Intervention between Young Male and Female Patients with Acute Coronary Syndrome

“…10,12 Prior studies have reported that intracoronary stents have been used less frequently among young women with ACS, although the use of DES has been more frequent among females 10 or comparable among both genders. 21 On the contrary, in our study, significantly fewer young females received a DES (81.1% vs 96.8%, p=0.001), possibly explained by the financial constraints, and lesser spending capacity for women in these populations.…”

Gender Differences in Clinical, Angiographic and Procedural Profiles between Young Patients with Acute Coronary Syndrome undergoing Percutaneous Coronary Intervention

“…[16][17][18] Multiple well-designed studies have found that, in comparison to age-matched men, women less than 50 to 55 years may be at higher risk for more adverse short-term outcomes and cardiovascular events particularly following PCI. 14,[18][19][20][21] The highest risk for women has been observed up to the age of 50-60 years. 20 Younger women have shown greater prevalence of hypertension, diabetes mellitus, cerebrovascular disease, renal impairment and congestive heart failure in comparison to men.…”

“…20 Younger women have shown greater prevalence of hypertension, diabetes mellitus, cerebrovascular disease, renal impairment and congestive heart failure in comparison to men. 5,12,15,19,21 The use of oral contraceptives among young females have also been implicated in the greater incidence of MI, and subsequent adverse outcomes. 22 Diabetes mellitus is a particularly strong risk factor for CAD in women 14 and is associated with a heightened cardiovascular mortality particularly in women <55 years.…”

“…23,24 Despite a greater prevalence of risk factors, young women <50 years presenting with ACS are known to have better left ventricular (LV) ejection fraction (EF), 12,19,25 and most notably, less severe/ extensive angiographic CAD. 5,19,21 Up to 50% of women presenting with ACS may have angiographically non-obstructive or nonatherosclerotic coronary artery disease that does not translate to favourable outcomes. 26 In most studies, women were less likely to have multivessel disease, ulcerated plaque overlying thrombus, 20,21 ACC/AHA type B2/C lesions, 12,21 or bypass graft lesion than men.…”

“…5,19,21 Up to 50% of women presenting with ACS may have angiographically non-obstructive or nonatherosclerotic coronary artery disease that does not translate to favourable outcomes. 26 In most studies, women were less likely to have multivessel disease, ulcerated plaque overlying thrombus, 20,21 ACC/AHA type B2/C lesions, 12,21 or bypass graft lesion than men. 5,20 The present study was done to compare the gender-based differences of clinical, angiographic and procedural profiles among young patients with ACS undergoing PCI.…”