CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY
Improved outcomes for women undergoing contemporary percutaneous coronary intervention
A report from the national heart, lung, and blood institute dynamic registry
Alice K. Jacobs, MD, FACC*,*,
Janet M. Johnston, PhD ,
Amelia Haviland,
Maria Mori Brooks, PhD,
Sheryl F. Kelsey, PhD,
David R. Holmes, Jr, MD, FACC ,
David P. Faxon, MD, FACC ,
David O. Williams, MD, FACC|| and
Katherine M. Detre, MD, DrPH, FACC
* Evans Memorial Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Mayo Clinic, Rochester, Minnesota, USA
University of Chicago, Chicago, Illinois, USA
|| Rhode Island Hospital, Providence, Rhode Island, USA
Manuscript received February 23, 2001;
revised manuscript received February 5, 2002,
accepted February 25, 2002.
* Reprint requests and correspondence: Dr. Alice K. Jacobs, Section of Cardiology, Boston Medical Center, 88 East Newton Street, Boston, Massachusetts 02118.
alice.jacobs{at}bmc.org
OBJECTIVES: The goal of this study was to determine whether women undergoing contemporary percutaneous coronary intervention (PCI) remain at increased risk in comparison with men and whether the outcomes in women have improved.
BACKGROUND: Previous studies have shown that women treated with coronary angioplasty have a higher incidence of procedural morbidity and mortality than men.
METHODS: Gender differences in wave 1 of the National Heart, Lung and Blood Institute (NHLBI) Dynamic registry were evaluated. Baseline characteristics and outcomes in women in the Dynamic registry were compared with those in women in the 1985–1986 and 1993–1994 NHLBI Percutaneous Transluminal Coronary Angioplasty (PTCA) registries.
RESULTS: Women were older with a higher prevalence of diabetes mellitus, hypertension, congestive heart failure, unstable angina and single vessel disease in comparison with men. Although procedural success and in-hospital death (2.2% vs. 1.3%), myocardial infarction (MI) (2.3% vs. 3.0%) and coronary artery bypass graft surgery (CABG) (1.3% vs. 1.4%) were similar in women and men, respectively, one-year mortality (6.5% vs. 4.3%, p = 0.02) and combined end point of death/MI/CABG (18.3% vs. 14.4%, p = 0.03) were higher in women than in men. After controlling for other factors, gender was not a significant predictor of death or death plus MI at one year. Despite a higher risk profile in women in the Dynamic registry in comparison with women in the 1985–1986 NHLBI PTCA registry, in-hospital death/MI/CABG was lower (6.0% vs. 11.6%, p < 0.001).
CONCLUSIONS: Despite persistent high-risk characteristics in women, gender differences in outcomes in patients undergoing contemporary PCI have decreased, and outcomes in women have improved.
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Abbreviations and Acronyms
| | CABG | | coronary artery bypass graft surgery | | CI | | confidence interval | | CPK | | creatine phosphokinase | | LDH | | lactic dehydrogenase | | MI | | myocardial infarction | | NHLBI | | National Heart, Lung and Blood Institute | | OR | | odds ratio | | PCI | | percutaneous coronary intervention | | PTCA | | percutaneous transluminal coronary angioplasty | | RR | | relative risk |
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