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

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Abstract

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.

Abbreviations

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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Supported, in part, by NHLBI grant HL 33292-14.