|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2002; 40:2092-2101 © 2002 by the American College of Cardiology Foundation |
,*
||
||
* Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
Clinical Research Section, Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA
Center for Evaluative and Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire, USA
Division of Health Services Research, Maine Medical Center, Portland, Maine, USA
|| Division of Cardiology, Department of Medicine, Maine Medical Center, Portland, Maine, USA
¶ Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
# Catholic Medical Center, Manchester, New Hampshire, USA
** Eastern Maine Medical Center, Bangor, Maine, USA
Division of Cardiology, Fletcher Allen Health Care, Burlington, Vermont, USA
Manuscript received February 22, 2002; revised manuscript received June 20, 2002, accepted July 15, 2002.
* Reprint requests and correspondence: Dr. David J. Malenka, Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
david.malenka{at}hitchcock.org
OBJECTIVES: We sought to determine whether the changing practice of interventional cardiology has been associated with improved outcomes for women, and how these outcomes compare with those for men.
BACKGROUND: Previous work from the early 1990s suggested women are at a higher risk than men for adverse outcomes after percutaneous coronary interventions (PCIs).
METHODS: From 1994 to 1999 data were collected on 33,666 consecutive hospital admissions for a PCI in Northern New England. Multivariate models were used to adjust for differences in case-mix across year of procedure when comparing outcomes. Direct standardization was used to calculate adjusted rates.
RESULTS: From 1994 to 1999, the case-mix worsened for both women and men, although women had more co-morbidities than did men throughout the period. Stent use increased over time (>75% in 1999). Concomitantly, the need for emergency coronary artery bypass graft surgery (CABG) decreased significantly (ptrend 
0.001; in 1999: 0.06% for women, 0.05% for men). Although the emergency CABG rates were higher for women at the beginning of the study, by the end, they were comparable (adjusted odds ratio 1.34, 95% confidence interval 0.76 to 2.38, p = 0.315). The myocardial infarction (MI) rates decreased over time for both women (by 29.7%, ptrend = 0.378) and men (by 37.6%, ptrend = 0.009) and did not differ by gender. The mortality rates did not decrease significantly over time and were not significantly different between the genders (mean 1.21% for women, 1.06% for men; p = 0.096).
CONCLUSIONS: Concurrent with the changing practice of PCI, and despite treating sicker patients, there have been important improvements in post-PCI CABG and MI rates for women, as well as for men. Unlike in earlier years, there are no longer significant differences in outcomes by gender.
| ||||||||||||||||||||||
This article has been cited by other articles:
|
|
 |
|
  M. Singh, C. S. Rihal, B. J. Gersh, V. L. Roger, M. R. Bell, R. J. Lennon, A. Lerman, and D. R. Holmes Jr Mortality differences between men and women after percutaneous coronary interventions. A 25-year, single-center experience. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2313 - 2320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. F. Wilson and G. Raveendran What's good for the gander is now good for the goose. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2321 - 2322. [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Doyle, H. H. Ting, M. R. Bell, R. J. Lennon, V. Mathew, M. Singh, D. R. Holmes, and C. S. Rihal Major Femoral Bleeding Complications After Percutaneous Coronary Intervention: Incidence, Predictors, and Impact on Long-Term Survival Among 17,901 Patients Treated at the Mayo Clinic From 1994 to 2005 J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 202 - 209. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J Bradshaw and P. L Thompson Sex in the CCU: women with non-ST-segment elevation acute coronary syndrome may do no worse despite less intervention Heart, November 1, 2007; 93(11): 1327 - 1328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Radovanovic, P. Erne, P. Urban, O. Bertel, H. Rickli, J.-M. Gaspoz, and on behalf of the AMIS Plus Investigators Gender differences in management and outcomes in patients with acute coronary syndromes: results on 20 290 patients from the AMIS Plus Registry Heart, November 1, 2007; 93(11): 1369 - 1375. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. R. Reynolds, M. E. Farkouh, A. M. Lincoff, A. Hsu, E. Swahn, Z. P. Sadowski, J. A. White, E. J. Topol, J. S. Hochman, and for the GUSTO V Investigators Impact of Female Sex on Death and Bleeding After Fibrinolytic Treatment of Myocardial Infarction in GUSTO V Arch Intern Med, October 22, 2007; 167(19): 2054 - 2060. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Gerber, C. S. Rihal, T. M. Sundt III, J. M. Killian, S. A. Weston, T. M. Therneau, and V. L. Roger Coronary Revascularization in the Community: A Population-Based Study, 1990 to 2004 J. Am. Coll. Cardiol., September 25, 2007; 50(13): 1223 - 1229. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. L. Lazar, T. Keilani, C. A. Fitzgerald, O. M. Shapira, C. T. Hunter, R. J. Shemin, H. C. Marsh Jr, U. S. Ryan, and the TP10 Cardiac Surgery Study Group Beneficial Effects of Complement Inhibition With Soluble Complement Receptor 1 (TP10) During Cardiac Surgery: Is There a Gender Difference? Circulation, September 11, 2007; 116(11_suppl): I-83 - I-88. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. B. King III, T. Aversano, W. L. Ballard, R. H. Beekman III, M. J. Cowley, S. G. Ellis, D. P. Faxon, E. L. Hannan, J. W. Hirshfeld Jr, A. K. Jacobs, et al. ACCF/AHA/SCAI 2007 Update of the Clinical Competence Statement on Cardiac Interventional Procedures: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Update the 1998 Clinical Competence Statement on Recommendations for the Assessment and Maintenance of Proficiency in Coronary Interventional Procedures) J. Am. Coll. Cardiol., July 3, 2007; 50(1): 82 - 108. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Pilote, K. Dasgupta, V. Guru, K. H. Humphries, J. McGrath, C. Norris, D. Rabi, J. Tremblay, A. Alamian, T. Barnett, et al. A comprehensive view of sex-specific issues related to cardiovascular disease Can. Med. Assoc. J., March 13, 2007; 176(6): S1 - S44. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G W Mikhail Coronary revascularisation in women Heart, May 1, 2006; 92(suppl_3): iii19 - iii23. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. N. Bairey Merz, L. J. Shaw, S. E. Reis, V. Bittner, S. F. Kelsey, M. Olson, B. D. Johnson, C. J. Pepine, S. Mankad, B. L. Sharaf, et al. Insights From the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part II: Gender Differences in Presentation, Diagnosis, and Outcome With Regard to Gender-Based Pathophysiology of Atherosclerosis and Macrovascular and Microvascular Coronary Disease J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S21 - S29. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Jacobs Women, Ischemic Heart Disease, Revascularization, and the Gender Gap: What Are We Missing? J. Am. Coll. Cardiol., February 7, 2006; 47(3_Suppl_S): S63 - S65. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Malenka, B. J. Leavitt, M. J. Hearne, J. F. Robb, Y. R. Baribeau, T. J. Ryan, R. E. Helm, M. A. Kellett, H. L. Dauerman, L. J. Dacey, et al. Comparing Long-Term Survival of Patients With Multivessel Coronary Disease After CABG or PCI: Analysis of BARI-Like Patients in Northern New England Circulation, August 30, 2005; 112(9_suppl): I-371 - I-376. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Lansky, J. S. Hochman, P. A. Ward, G. S. Mintz, R. Fabunmi, P. B. Berger, G. New, C. L. Grines, C. G. Pietras, M. J. Kern, et al. Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women: A Statement for Healthcare Professionals From the American Heart Association Circulation, February 22, 2005; 111(7): 940 - 953. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. M. Shrive, B. J. Manns, P. D. Galbraith, M. L. Knudtson, W. A. Ghali, and for The APPROACH Investigators Economic evaluation of sirolimus-eluting stents Can. Med. Assoc. J., February 1, 2005; 172(3): 345 - 351. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. E. Wennberg, F. L. Lucas, A. E. Siewers, M. A. Kellett, and D. J. Malenka Outcomes of Percutaneous Coronary Interventions Performed at Centers Without and With Onsite Coronary Artery Bypass Graft Surgery JAMA, October 27, 2004; 292(16): 1961 - 1968. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T.C. Clayton, S.J. Pocock, R.A. Henderson, P.A. Poole-Wilson, T.R.D. Shaw, R. Knight, and K.A.A. Fox Do men benefit more than women from an interventional strategy in patients with unstable angina or non-ST-elevation myocardial infarction? The impact of gender in the RITA 3 trial Eur. Heart J., September 2, 2004; 25(18): 1641 - 1650. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Bittl, D. P. Chew, E. J. Topol, D. F. Kong, and R. M. Califf Meta-Analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty J. Am. Coll. Cardiol., March 17, 2004; 43(6): 936 - 942. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. B. King III Why Have Stents Replaced Balloons? Underwhelming Evidence Ann Intern Med, May 20, 2003; 138(10): 842 - 843. [Full Text] [PDF]
|
|
|
|
 |
|
 Outcomes Continue to Improve for Women Treated with PCI Journal Watch Women's Health, February 19, 2003; 2003(219): 7 - 7. [Full Text]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
