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Whether outcomes differ for women and men after percutaneous coronary intervention (PCI) for elderly patients remains controversial. We sought to compare the 2-year outcomes by sex in Chinese elderly patients over 60 years of age undergoing PCI for coronary heart disease.
Consecutive patients aged ≥60 years who underwent percutaneous coronary intervention at a single center in the People’s Republic of China from January 2013 to December 2013 were included in this cohort study. Outcomes included a 2-year risk of major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding according to Bleeding Academic Research Consortium (BARC) definitions. MACCE was defined as a composite of death, myocardial infarction, unplanned revascularization, stent thrombosis and stroke. Hazard ratios were generated using multivariable Cox proportional hazards regression.
A total of 4926 patients (33.6% women, mean age 67.4 ± 5.7 years) were recruited. In this cohort, the prevalence of diabetes (34.9% vs 30.8%, p=0.003) and hypertension (75.3% vs 66.3%, p＜0.001) was higher among women compared with men.
Women were older, had lower estimated glomerular filtration rate (eGFR) (81.6 ± 15.6 vs 84.0 ± 13.4, p＜0.001) and lower hemoglobin (128.7 ± 12.8 vs 143.9 ± 14.4 g/L, p＜0.001). After 2-year follow up, no significant differences were observed between men and women in all-cause mortality (1.9% vs 1.8%, p=0.839), myocardial infarction (2.1% vs 2.4%,p=0.626), unplanned revascularization (8.4% vs 7.1%, p=0.109), stent thrombosis (1.1% vs 0.9%, p=0.466) or stroke (1.7% vs 2.2%, p=0.232).
Unadjusted cumulative incidence of 2-year MACCE was not statistically different between men and women (13.1% vs 11.8%, p=0.216). Female sex was associated with higher risks of postdischarge BARC bleeding (9.2% vs 6.2%, p<0.001). Differences persisted after adjustment (hazard ratio [HR] 1.30, 95% confidence interval [CI] 1.02-1.67; p =0.037).
This study found that elderly women undergoing PCI were at increased risk of 2-year bleeding as compared to men. The results may attribute to baseline differences. Further dedicated studies are needed to confirm these findings and give attention to the high-risk subset.