Purpose: Conflicting information exists on sex-based differences in outcomes after percutaneous coronary intervention (PCI). In addition, previous data may not be reflective of the entire general clinical population, as most studies were post-hoc analyses of clinical trials with inherent possibility of a differential attrition rate in the pre-randomization phase by sex. Methods: We investigated the relationship between sex and the risks of shortclinical outcomes after PCI in current practice, using data on 13259 acute coronary syndromes (ACS) consecutive patients from January 2010 to January 2015. Patients treated in a conservative manner or with CABG were excluded, leaving a final study population of 7792 patients who underwent PCI (28.7% were women). Cox proportional hazards regression model was adjusted to covariates significantly different between groups in univariate analysis. The primary endpoint was 30-days mortality; the secondary endpoint was the composite of cardiovascular mortality, stent thrombosis, stroke or major bleeding; the tertiary endpoint was left ventricular dysfunction (LVD) defined as an LV ejection fraction <40% at echocardiography Results: Women were older (mean age: 65.5 vs. 59.7 years, p<0.001), had higher rates of diabetes (30.9% vs. 22.0%, p<0.001), hypertension (77.8% vs. 65.6%, p<0.001), cerebrovascular disease (4.7% vs. 3.3%, p=0.003) and higher rates of Killip class ≥2 (25.1% vs. 19.6%, p<0.001), but lower rates of smoking (30.3% vs. 45.3%, p<0.001) than male patients. Unadjusted mortality was significantly higher in women than men (7.1% vs. 4.4%, p<0.001), as well as the overall the rates of the secondary endpoint (10.5% vs. 7.1%, p<0.001). No differences were observed in the unadjusted rates of the tertiary endpoint (19.1% vs. 21.2%, p=0.16). After multivariable adjustment, female sex was no longer associated with a higher risk of death (HR: 1.13, 95% CI: 0.87–1.48) and higher risk of secondary endpoint (HR: 1.18, 95% CI: 0.97–1.45). On the contrary female sex was associated with lower risk of LVD (adjusted HR: 0.73, 95% CI: 0.60–0.89). These sex-specific findings for outcomes were consistent across patient subgroups using bare metal stents (HR: 1.25, 95% CI: 0.88–1.77) or drug-eluting stents (HR: 1.13, 95% CI: 0.78–1.62). Conclusions: In our cohort, among patients undergoing contemporary PCI, no differences in short-terms major cardiovascular outcomes were observed between women and men. Women undergoing PCI has a lower risk of LVD than men. There was no association between sex and stent type on short-term outcomes.

Gender differences on short term outcomes after contemporary percutaneous coronary intervention

CENKO, EDINA;RICCI, BEATRICE;MANFRINI, OLIVIA;BUGIARDINI, RAFFAELE
2015

Abstract

Purpose: Conflicting information exists on sex-based differences in outcomes after percutaneous coronary intervention (PCI). In addition, previous data may not be reflective of the entire general clinical population, as most studies were post-hoc analyses of clinical trials with inherent possibility of a differential attrition rate in the pre-randomization phase by sex. Methods: We investigated the relationship between sex and the risks of shortclinical outcomes after PCI in current practice, using data on 13259 acute coronary syndromes (ACS) consecutive patients from January 2010 to January 2015. Patients treated in a conservative manner or with CABG were excluded, leaving a final study population of 7792 patients who underwent PCI (28.7% were women). Cox proportional hazards regression model was adjusted to covariates significantly different between groups in univariate analysis. The primary endpoint was 30-days mortality; the secondary endpoint was the composite of cardiovascular mortality, stent thrombosis, stroke or major bleeding; the tertiary endpoint was left ventricular dysfunction (LVD) defined as an LV ejection fraction <40% at echocardiography Results: Women were older (mean age: 65.5 vs. 59.7 years, p<0.001), had higher rates of diabetes (30.9% vs. 22.0%, p<0.001), hypertension (77.8% vs. 65.6%, p<0.001), cerebrovascular disease (4.7% vs. 3.3%, p=0.003) and higher rates of Killip class ≥2 (25.1% vs. 19.6%, p<0.001), but lower rates of smoking (30.3% vs. 45.3%, p<0.001) than male patients. Unadjusted mortality was significantly higher in women than men (7.1% vs. 4.4%, p<0.001), as well as the overall the rates of the secondary endpoint (10.5% vs. 7.1%, p<0.001). No differences were observed in the unadjusted rates of the tertiary endpoint (19.1% vs. 21.2%, p=0.16). After multivariable adjustment, female sex was no longer associated with a higher risk of death (HR: 1.13, 95% CI: 0.87–1.48) and higher risk of secondary endpoint (HR: 1.18, 95% CI: 0.97–1.45). On the contrary female sex was associated with lower risk of LVD (adjusted HR: 0.73, 95% CI: 0.60–0.89). These sex-specific findings for outcomes were consistent across patient subgroups using bare metal stents (HR: 1.25, 95% CI: 0.88–1.77) or drug-eluting stents (HR: 1.13, 95% CI: 0.78–1.62). Conclusions: In our cohort, among patients undergoing contemporary PCI, no differences in short-terms major cardiovascular outcomes were observed between women and men. Women undergoing PCI has a lower risk of LVD than men. There was no association between sex and stent type on short-term outcomes.
2015
E. Cenko; B. Ricci; Z. Vasiljevic; B. Knezevic; D. Trninic; D. Milicic; S. Kedev; O. Manfrini; L. Badimon; R. Bugiardini
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/528474
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