Author + information
- Gennaro Giustino1,
- Robert Saporito2,
- Usman Baber3,
- Melissa Aquino4,
- George Dangas5,
- Jason Kovacic6,
- Pedro R. Moreno7,
- Swathi Roy8,
- Prakash Krishnan9,
- Joe Sweeny9,
- Roxana Mehran3,
- Annapoorna Kini10 and
- Samin K. Sharma6
- 1Icahn School of Medicine at Mount Sinai, New York City, NY
- 2Mount Sinai Medical Center, New York, NY
- 3Icahn School of Medicine at Mount Sinai, New York, United States
- 4The Icahn of Medicine at Mount Sinai, New York, NY
- 5Mount Sinai, New York, New York, United States
- 6Mount Sinai School of Medicine, New York, United States
- 7Mount Sinai Medical Center, New York, United States
- 8Mount Sinai Medical Center, New York City, NY
- 9Mount Sinai School of Medicine, New York City, NY
- 10mount Sinai, New York, NY
Women with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) are at higher risk of early and late major adverse cardiac events (MACE) compared with male subjects. Moreover, previous studies suggest a differential prognostic impact of clinical presentation between genders. In this study, we sought to investigate the effect of gender according to clinical presentation on clinical outcomes.
We retrospectively analyzed patients from a large single-center PCI registry treated between January 2009 and December 2013. Study population was categorized according to gender and presence or not of myocardial infarction (MI) at time of PCI. Endpoints of interest were all-cause mortality, MI and cerebrovascular events (CVEs) at 1 year after the index procedure.
Out of 15,988 patients included in the present analysis, 10,764 (67%) were males and 5224 (33%) were females. Of them, 1,198 (7%) and 672 (4%) presented with an MI in the male and female group, respectively. In both groups, women were older, more commonly affected by multiple comorbidities but had lower CAD complexity compared with men. A stepwise increase in the rates of mortality, MI and CVE was observed in the transition from male with no MI, to female with no MI, to male with MI to female with MI (Figure 1). Following multivariable adjustment for baseline confounders, women with MI had similar risk of all-cause mortality (HR: 1.02; 95% CI: 0.81 – 1.28), MI (HR: 1.55; 95% CI: 0.93 – 2.59) and CVE (HR: 2.44; 95% CI: 0.64 – 9.36) to that of the male counterpart. The effect of gender across clinical presentation was uniform, without evidence for interaction for the investigated outcomes.
After PCI, most of the risk associated with female gender is attributable to the presence of concomitant clinical comorbidities. The adjusted effect of gender on outcomes was uniform between clinical presentations.
CORONARY: PCI Outcomes
Acute coronary syndromes, Women