Persistent sex difference in hospital outcome following percutaneous coronary intervention: results from the New York State reporting system.

BACKGROUND

Although sex-related differences in early outcomes have been observed in young women following acute myocardial infarction (AMI) and coronary bypass surgery, evidence for similar differences following percutaneous coronary intervention (PCI) is lacking.

METHODS

Using the 1999 to 2002 New York State PCI reporting system, we identified 11,162 men and 2,561 women aged 50 years or younger undergoing a first PCI procedure. In-hospital outcomes were compared by gender after multivariable adjustment for baseline, clinical and procedural characteristics.

RESULTS

Young women undergoing an initial PCI procedure were more likely to belong to racial or ethnic minorities and exhibit more comorbidities than young men. However, they had better ejection fraction (52.9% +/- 11.3 vs. 51.9 +/- 11; p = 0.0002) and presented more often with single-vessel disease (75% vs. 67%; p < 0.0001). Despite women receiving glycoprotein IIb/IIIa inhibitors (58.6% vs. 65.1%; p < 0.0001) and stents (92.5% vs. 94.9%; p < 0.0001) less often, procedural success was achieved equally (97% vs. 96%). Young women experienced higher rates of in-hospital mortality (0.70% vs. 0.22%; p < 0.0001), and vascular damage (0.82% vs. 0.24%; p < 0.0001) compared to men. In multivariable analysis, female sex independently predicted in-hospital mortality (OR 4.0, 95% CI: 1.9 to 8.1) after adjustment for urgency of PCI, clinical and procedural characteristics.

CONCLUSION

A gender-based difference in early survival exists in young women undergoing a first PCI procedure. Further investigation into the mechanism of this higher risk is warranted.