Percutaneous Coronary Intervention in Women: In-Hospital Clinical Outcome : Experience from a Single Private Institution in Melbourne - 15/08/11

Doi : 10.1016/j.hlc.2008.08.002

Ernesto Oqueli, MD ^⁎ , Leonie Baker, GradDipClinEpidemiology, Aaron Carroll, BAppSci, Martin Hiscock, FRACP, Ronald Dick, FRACP
Victorian Heart Centre, Epworth Hospital Richmond, Victoria, Australia

Corresponding author at: Department of Cardiology, Western Hospital, Gordon Street, Footscray 3011, Victoria, Australia. Tel.: +61 3 83456056; fax: +61 3 83456055.

Résumé

Background

Differences in outcome between women and men treated with percutaneous coronary intervention (PCI) have decreased. This study was aimed at assessing the demographic, clinical, and angiographic features, procedural characteristics and in-hospital results of women undergoing PCI and comparing their results with those of a group of men undergoing PCI throughout the same period of time.

Methods and Results

All consecutive PCI procedures performed at Epworth Hospital from November 2004 to January 2007 were analysed. Women and men were compared according to baseline clinical, angiographic and procedural characteristics, angiographic success rates and in-hospital outcomes.

A total of 1699 consecutive PCI procedures were performed; of these, 405 PCI (23.8%) were performed in women. Women were older (73.9±10 years versus 66.1±11.9 years, p<0.0001), had a higher prevalence of hypertension (78% versus 63%, p<0.0001), had lower prevalence of prior myocardial infarction (21% versus 27%, p=0.026), and had less history of prior coronary artery by-pass surgery (13% versus 18%, p=0.023) than men. A greater proportion of women presented with acute coronary syndromes (ACS) to PCI than men (63.7% versus 52.9%, p<0.0001).

Women had more complex lesions B2/C (78% versus 74%, p=0.049), a higher proportion of ostial lesions (10.5% versus 5.5%, p<0.0001) and less multivessel disease (48% versus 54% p=0.028) than men. Angiographic lesion success rates were similar in both groups.

Total unadjusted in-hospital mortality was higher in women than in men (1.97% versus 0.54%, respectively, p=0.013). This difference in mortality was only at the expense of a higher unadjusted mortality in women presenting with ST segment elevation myocardial infarction (STEMI) than men (17.5% versus 1.87%, p=0.002). No women with a stable coronary syndrome or non-ST-segment elevation acute coronary syndrome (NSTE-ACS) died in hospital. There were no differences in in-hospital myocardial infarction, new revascularisation or stroke between both groups.

Conclusions

PCI in women has good results but carries an increased unadjusted mortality than in men. This mortality difference between genders in our study, however, was solely at the expense of a higher unadjusted mortality in women than in men undergoing PCI for STEMI.

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Keywords : Percutaneous coronary intervention, PCI in women, PCI and gender differences, Drug eluting stents and women, In-hospital outcomes post PCI and gender