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Younger women undergoing PCI at risk for long-term MACE
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Women aged 45 years or younger treated with PCI had a nearly 20% risk for MACE at 3 years, driven largely by high rates of target vessel revascularization, according to study data published in the American Journal of Cardiology.
The retrospective analysis was conducted by researchers at the Capital Medical University in Beijing and the University of Texas Medical Branch and included 168 consecutive women aged 45 years or younger (mean age, 40.3 years) who underwent PCI. They defined the primary endpoint as the incidence of MACE at short- and long-term follow-up.
Most patients (93.5%) had conventional CAD risk factors. Autoimmune or connective tissue diseases were present in 6.5% of patients, and 4% had gynecologic diseases — four were postpartum and nine were taking contraceptives. The left anterior descending coronary artery was the most commonly affected vessel (83.3%) and the most common vessel for stenting (76.8%).
In all, 268 stents were implanted, most of which (95.3%) were drug-eluting stents. During hospital stay, the rate of MACE was 1.2%, and one patient died. At 30 days, no additional events occurred.
Median follow-up at 36 months showed a cumulate MACE-free survival of 80.5%, with rates of TVR of 16.5% and stent thrombosis of 3.6%. Researchers reported the following independent predictors of MACE on multivariate analysis: hypertension (P=.01), smoking (P=.04), left ventricular ejection fraction <50% (P=.02), anterior MI (P=.04) and immunologic disease (P=.0007).
The high incidence of left anterior descending coronary artery lesions and anterior MI, the researchers wrote, could partially explain why young female patients had increased mortality after acute MI in comparison with older female and male patients.
“Although conventional risk factors remain a dominant issue, some nonconventional risk factors, such as autoimmune diseases, may contribute to the worse long-term outcomes,” they said
Disclosure: The researchers report no relevant financial disclosures.
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