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In patients with normal renal function recent trial and registry data suggests that mortality between men and women are similar after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). In contrast, there is an incomplete understanding of gender differences in the end-stage renal disease (ESRD) cohort after coronary revascularization by the above techniques.
Within Kaiser Permanente Northern California, a large integrated health care delivery system we identified 1015 adults with ESRD undergoing CABG or PCI between 1996 and 2008. We ascertained patient characteristics, longitudinal prescription drug exposure, primary outcome (all-cause mortality), secondary outcomes (myocardial infarction (MI), hospitalization and repeat revascularization) using validated algorithms based on health plan databases, state death certificate files and Social Security Administration files. An initial bivariate analysis along with standard and extended Cox regression models were performed. An interaction was tested between gender and revascularization type.
Although baseline categorized age was similar between men and women, duration of dialysis prior to revascularization (p=0.047), history of tobacco use (p<0.0001), diabetes mellitus (p=0.03), hyperlipidemia (p=0.02), lung disease (p=0.014), use of angiotensin receptor blockers (p=0.05), diabetes medications (p=0.02) and mode of revascularization (p<0.0001) varied when stratified by gender. In the risk adjusted model the association (HR, 95% CI) of female gender to death (0.96, 0.80-1.16), MI (1.06, 0.78-1.43), hospitalization (0.93, 0.52-1.66) & repeat revascularization (0.95, 0.69-1.32) were similar to men. Addition of baseline & time-varying medications did not significantly affect the association. No interaction was noted between gender and revascularization type.
Similar to the results of recent studies in patients with normal renal function who had undergone coronary revascularization, we noted that women with ESRD after coronary revascularization had similar cardiovascular outcomes compared to their male counterparts.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Rock and a Hard Place: Chronic Kidney Disease and the Heart
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1193-61
- 2013 American College of Cardiology Foundation