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ALKK-PCI registry: Women less likely to receive DES than men
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MUNICH — Results from the German ALKK-PCI registry highlight a gender discrepancy in CAD management, suggesting that women are less likely to receive drug-eluting stents compared with men, particularly as they age.
“There are gender-related differences in the treatment of CAD between women and men,” Martin Russ, MD, with the Amper-Kliniken in Dachau, Germany, said during a presentation. “Women do not receive the best available evidence-based therapy as often as men. Furthermore, women are less likely to receive invasive diagnosis and treatment for CAD.”
To determine if there are differences in the use of DES between women and men, Russ and colleagues prospectively collected data from 100,704 PCIs from 28 centers from the German ALKK-PCI registry from the first quarter 2005 until the fourth quarter 2009.
According to study results, women were less likely to receive a DES if they had stable CAD (34.5% vs. 38.5%; P<.001) non-STEMI (24.8% vs. 27.3%; P<.001) and STEMI (15.9% vs. 16.9%; P=.086). Women were also less likely to receive a DES if they were between 70 to 80 years of age (27.1% vs. 29.9%; P<.001) and older than 80 years (18.5% vs. 23.1%; P<.001).
“Women are more likely to receive bare-metal stents instead of DES. This effect is pronounced with higher age,” Russ concluded. “Overall, the use of DES is quite low, given that the use of DES is a 1A recommendation of European Society of Cardiology guidelines.” – by Brian Ellis
For more information:
Russ M. Abstract #90. Presented at: European Society of Cardiology Congress; August 25-29, 2012; Munich.
Disclosure: Dr. Russ reports no relevant financial disclosures.
Perspective
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Roxana Mehran, MD
One cannot move away from the probable underlying reason of this discrepancy that is not captured in case-report forms, which is the perception of increased rate of bleeding in older women and the impact of prolonged dual antiplatelet therapy in this population. From these data, it is beyond the age of 70 years where the differential in DES usage is seen in female patients, as is the risk for bleeding. Therefore, I do believe that this factor is playing a role in this study. It is important to note that in the United States, the National Cardiovascular Data Registry (NCDR) only looks at in-hospital events. I think the fear has to do with the prolonged /chronic use of DAPT in the patients, especially in the elderly — male or female. That is where there is less enthusiasm for DES.
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