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Gender may influence procedural risk, long-term survival with coronary stents
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In the largest study to date to address sex-based outcomes after coronary stenting, researchers found that women had a slightly higher procedural risk than men but better long-term survival with coronary stenting, whereas drug-eluting stents in both sexes were associated with less mortality, MI and revascularization than bare-metal stents.
In the study, investigators compared in-hospital outcomes by sex and long-term outcomes after coronary stenting by linking data on nearly 427,000 patients aged at least 65 years (42.3% women) from the National Cardiovascular Data Registry CathPCI Registry to Medicare inpatient claims.
In-hospital complications were more frequent in women than men, including death (2.2% vs. 1.6%; adjusted OR=1.41; 95% CI, 1.33-1.49), MI (1.3% vs. 1.2%; OR=1.19; 95% CI, 1.11-1.27) bleeding (4.4% vs. 2.3%; OR=1.86; 95% CI 1.79-1.93) and vascular complications (1.3% vs. 0.7%; OR=1.85; 95% CI, 1.73-1.99).
At median follow-up of 20.4 months, women had a lower adjusted risk for death (HR=0.92; 95% CI, 0.9-0.94) but similar rates of MI, revascularization and bleeding. In both sexes, DES use compared with BMS was associated with improved long-term rates of mortality (women: adjusted HR=0.78; 95% CI, 0.76-0.81; men: HR=0.77; 95% CI, 0.74-0.79) MI (women: HR=0.79; 95% CI, 0.74-0.84; men: HR=0.81; 95% CI, 0.77-0.85) and revascularization (women: HR=0.93; 95% CI, 0.9-0.97; men: HR=0.91; 95% CI, 0.88- 0.94).
Monique Anderson
“In the contemporary stenting period, sex still remains a significant risk factor for in-hospital death and complications and emphasizes the need for continued study in this area,” study investigator Monique Anderson, MD, with the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, told Cardiology Today Intervention. “In contrast, long-term outcomes are more similar between men and women, which possibly reflect similar secondary preventive care in both sexes after receipt of index stent.”
Disclosure: Anderson reports no relevant financial disclosures.
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