Long-Term Outcomes in Women and Men Following Percutaneous Coronary Intervention

J Am Coll Cardiol. 2020 Apr 14;75(14):1631-1640. doi: 10.1016/j.jacc.2020.01.056.

Abstract

Background: Studies examining sex-related outcomes following percutaneous coronary intervention (PCI) have reported conflicting results.

Objectives: The purpose of this study was to examine the sex-related risk of 5-year cardiovascular outcomes after PCI.

Methods: The authors pooled patient-level data from 21 randomized PCI trials and assessed the association between sex and major adverse cardiac events (MACE) (cardiac death, myocardial infarction [MI], or ischemia-driven target lesion revascularization [ID-TLR]) as well as its individual components at 5 years.

Results: Among 32,877 patients, 9,141 (27.8%) were women. Women were older and had higher body mass index, more frequent hypertension and diabetes, and less frequent history of surgical or percutaneous revascularization compared with men. By angiographic core laboratory analysis, lesions in women had smaller reference vessel diameter and shorter lesion length. At 5 years, women had a higher unadjusted rate of MACE (18.9% vs. 17.7%; p = 0.003), all-cause death (10.4% vs. 8.7%; p = 0.0008), cardiac death (4.9% vs. 4.0%; p = 0.003) and ID-TLR (10.9% vs. 10.2%; p = 0.02) compared with men. By multivariable analysis, female sex was an independent predictor of MACE (hazard ratio [HR:]: 1.14; 95% confidence interval [CI:]: 1.01 to 1.30; p = 0.04) and ID-TLR (HR: 1.23; 95% CI: 1.05 to 1.44; p = 0.009) but not all-cause death (HR: 0.91; 95% CI: 0.75 to 1.09; p = 0.30) or cardiac death (HR: 0.97; 95% CI: 0.73 to 1.29; p = 0.85).

Conclusions: In the present large-scale, individual patient data pooled analysis of contemporary PCI trials, women had a higher risk of MACE and ID-TLR compared with men at 5 years following PCI.

Keywords: mortality; outcomes; percutaneous coronary intervention; sex.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Coronary Angiography / methods
  • Coronary Angiography / statistics & numerical data
  • Coronary Artery Disease* / diagnosis
  • Coronary Artery Disease* / physiopathology
  • Coronary Artery Disease* / surgery
  • Coronary Vessels / diagnostic imaging
  • Female
  • Heart Disease Risk Factors
  • Humans
  • Long Term Adverse Effects* / diagnosis
  • Long Term Adverse Effects* / mortality
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Percutaneous Coronary Intervention / adverse effects*
  • Percutaneous Coronary Intervention / methods
  • Risk Assessment / methods
  • Risk Factors
  • Severity of Illness Index