Sex differences in early and long-term results of coronary angioplasty in the NHLBI PTCA Registry.

Publisher Website
Google Scholar
Abstract
To assess whether gender influenced the outcome of percutaneous transluminal coronary angioplasty (PTCA), data from the NHLBI [National Heart, Lung and Blood Institute] PTCA Registry was analyzed. Early results were compared in 705 women and 2374 men. Women were older (P < 0.01) and had more unstable angina (P < 0.01) and class 3 or 4 angina (P < 0.01). Men had more multivessel disease (P < 0.01), prior bypass surgery (P < 0.01) and abnormal left ventricular function (P < 0.05). Women had a lower angiographic success rate (60.3 vs. 66.2%; P < 0.01) and had a lower clinical success rate (56.6% vs. 62.2%; P < 0.01). More women had complications (27.2% vs. 19.4%; P < 0.01) but overall frequency of major complications (deaths, myocardial infarction, emergency surgery) was not different (9.8% vs. 9.3%). Women had a higher incidence of coronary dissection (P < 0.05) and higher in-hospital mortality (1.8% vs. 0.7%; P < 0.01). PTCA-related mortality was nearly 6 times higher in women (1.7% vs. 0.3%; %P < 0.001) and mortality with emergency surgery was more than 5 times higher (17.4% vs. 3.2%; P < 0.001). Multivariate analysis indicated that female gender was an independent predictor for lower success (P < 0.05) and early mortality (P < 0.05) and was the only baseline predictor for PTCA-related mortality. Late results in 2272 patients from centers with virtually complete follow-up of 1 yr or longer (mean 18 mo.) showed comparable or better results in women than men. Men had higher rates of angiographic restenosis (36% vs. 22%; P < 0.01), repeat PTCA (18% vs. 10%; P < 0.01), additional revascularization (27% vs. 18%; P < 0.01) and cumulative mortality (2.2% vs. 0.3%; P < 0.05), and frequency of symptomatic improvement similar to that in women. PTCA in women was associated with less favorable short-term outcome, lower initial success rate and higher mortality rate than in men. Longer-term results after PTCA were comparable or better in women, with similar symptomatic improvement, lower rates of restenosis and improved survival compared with men.