Women report poorer health status vs. men after nonprimary PCI
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Health status improved for men and women after nonprimary PCI, but researchers observed more limited improvement among women, with worse health status compared with men at 6 weeks and 9 months after PCI.
According to research published in Circulation: Cardiovascular Interventions, women were less likely than men to be free from angina at 6 weeks and 9 months after nonprimary PCI.
“Prior studies demonstrated that compared with men, women with CAD undergoing PCI have more comorbidities, are treated less aggressively, have higher rates of long-term morbidity, and post-procedure have worse functional status and more angina,” Pranoti G. Hiremath, MD, cardiology fellow at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, and colleagues wrote. “Identifying and understanding sex and gender-based differences is essential in minimizing those disparities amenable to modification.”
To this end, researchers utilized data collected during the CPORT-E trial, a noninferiority trial that compared outcomes among 18,867 patients randomly assigned to undergo nonprimary PCI at a hospital with or without an on-site cardiac surgery unit.
As Healio previously reported, patients who underwent nonprimary PCI at hospitals without on-site cardiac surgery had similar outcomes compared with patients treated at hospitals with cardiac surgery capability, and there was no significant difference in the incidence of other MACE, such as stroke, bleeding, renal failure and the need for vascular repair.
For the present analysis, researchers compared Seattle Angina Questionnaire scores at baseline, 6 weeks and 9 months among 6,851 women and 12,016 men who underwent nonprimary PCI to elucidate sex differences in medical treatment, clinical outcomes and health status outcomes.
Health status was assessed using the Seattle Angina Questionnaire, which includes quality of life, frequency of angina, physical limitation and treatment satisfaction for patients with CAD.
Differences in medical therapies
According to the study, women were less frequently prescribed statins at 9 months post-PCI compared with men (83.1% vs. 86.5%). Women also received less dual antiplatelet therapy at discharge compared with men (93% vs. 94.5%), although this difference narrowed over time.
Through 9 months, women were less frequently prescribed aspirin (92.4% vs. 94.4%) and more frequently prescribed P2Y12 inhibitors (88% vs. 86.9%) compared with men.
Beta-blocker use was similar for both men and women.
Differences in clinical and health status outcomes
Researchers observed no differences in 6-week all-cause mortality between men and women (1.12% vs. 0.84%; P = .053; adjusted OR = 1.15; 95% CI, 0.79-1.66; P = .47) or 9-month MACE (12.4% vs. 11.9%; P = .15; aOR = 1; 95% CI, 0.91-1.12; P = .87).
However, women experienced higher rates of bleeding (8.5% vs. 3.7%; aOR = 1.8; 95% CI, 1.4-2.5; P < .001), vascular repair (1.6% vs. 1.1%; aOR = 1.8; 95% CI, 1.6-2.1; P < .001) and repeated diagnostic catheterizations (16.4% vs. 12.4%; aOR = 1.41; 95% CI, 1.3-1.5; P < .001).
According to the study, health status as assessed by the Seattle Angina Questionnaire was poorer for women compared with men at baseline, 6 weeks and 9 months in all domains of the questionnaire (P for all < .001), except for treatment satisfaction (P at 6 weeks = .081; P at 9 months = .27).
“Health status increased significantly after PCI for both women and men and to a similar extent,” the researchers wrote. “However, with the exception of treatment satisfaction, women had poorer health status outcomes than men both before and after PCI even after adjusting for comorbidities and baseline health status.”
After adjusting for clinical characteristics, procedural characteristics and baseline Seattle Angina Questionnaire score, researchers reported that women had worse health status at 6 weeks (beta = 2.67; 95% CI, 3.08 to 2.27; P < .001) and 9 months (beta = 2.36; 95% CI, 2.74 to 1.97; P < .001) compared with men.
Women also had lower odds of freedom from angina at 6 weeks (OR = 0.66; 95% CI, 0.61-0.71; P < .001) and 9 months (OR = 0.68; 95% CI, 0.62-0.74; P < .001) compared with men.
“Sociocultural factors are implicated as potential causes of sex-based differences in health status. Culture-dependent gender-related factors ... are linked with greater health status disparities than those arising from biologic female sex alone. Indeed, the dependence of gender roles, behaviors, expressions and identities on culture is an important motivation for the current analysis,” the researchers wrote. “One immediate action providers can take to minimize disparities in health status is to optimize medical therapy equitably in women and men with established CAD.”
In a related editorial, Sonya N. Burgess, PhD, MBChB, interventional cardiologist at Nepean Hospital in Sydney, discussed how improvements in the implementation of existing guideline-based therapies could improve disparities in PCI outcomes.
“New innovations are undoubtably important, but we must also apply the evidence-based medicine we do have in a more systematic manner, for women and patients less likely to receive guideline-based care. Including more consistent referral and treatment thresholds, better use of radial access, potent P2Y12 inhibitors, referral to cardiac rehab, statin therapy and more aggressive management of cardiac risk factors, particularly hypertension and body mass index,” Burgess wrote. “Hiremath et al’s study is equity focused, timely and relevant, it serves as a reminder that we are far from closing the gender gap for women with cardiovascular disease and is a call to action to keep working toward better evidence-based solutions and to more consistent and equitable management strategies.”
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