CLINICAL STUDY
Gender-related changes in the practice and outcomes of percutaneous coronary interventions in northern New England from 1994 to 1999
David J. Malenka, MD* ,*,
David E. Wennberg, MD, MPH ||,
Hebe A. Quinton, MS ,
Daniel J. O’Rourke, MD, MS*,
Paul D. McGrath, MD, MS||,
Samuel J. Shubrooks, Jr, MD¶,
Gerry T. O’Connor, PhD, DSc,
Thomas J. Ryan, Jr, MD||,
John F. Robb, MD*,
Mirle A. Kellett, Jr, MD||,
William A. Bradley, MD#,
Michael A. Hearne, MD#,
Peter N. VerLee, MD**,
Matthew W. Watkins, MD,
Bruce D. Hettleman, MD*,
Winthrop D. Piper, MSc Northern New England Cardiovascular Disease Study Group
* 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.
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Abbreviations and Acronyms
| | BSA | | body surface area | | CABG | | coronary artery bypass graft surgery | | CHF | | congestive heart failure | | COPD | | chronic obstructive pulmonary disease | | DM | | diabetes mellitus | | GP | | glycoprotein | | LMCA | | left main coronary artery | | PCI | | percutaneous coronary intervention | | LVEDP | | left ventricular end-diastolic pressure | | MI | | myocardial infraction |
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