Gender-related changes in the practice and outcomes of percutaneous coronary interventions in Northern New England from 1994 to 1999.
OBJECTIVE
We sought to determine whether the changing practice of interventional cardiology has been associated with improved outcomes for women, and how these outcomes compare with those for men.


BACKGROUND
Previous work from the early 1990s suggested women are at a higher risk than men for adverse outcomes after percutaneous coronary interventions (PCIs). From 1994 to 1999 data were collected on 33,666 consecutive hospital admissions for a PCI in Northern New England. Multivariate models were used to adjust for differences in case-mix across year of procedure when comparing outcomes. Direct standardization was used to calculate adjusted rates.


RESULTS
From 1994 to 1999, the case-mix worsened for both women and men, although women had more co-morbidities than did men throughout the period. Stent use increased over time (>75% in 1999). Concomitantly, the need for emergency coronary artery bypass graft surgery (CABG) decreased significantly (p(trend) < or = 0.001; in 1999: 0.06% for women, 0.05% for men). Although the emergency CABG rates were higher for women at the beginning of the study, by the end, they were comparable (adjusted odds ratio 1.34, 95% confidence interval 0.76 to 2.38, p = 0.315). The myocardial infarction (MI) rates decreased over time for both women (by 29.7%, p(trend) = 0.378) and men (by 37.6%, p(trend) = 0.009) and did not differ by gender. The mortality rates did not decrease significantly over time and were not significantly different between the genders (mean 1.21% for women, 1.06% for men; p = 0.096).


CONCLUSIONS
Concurrent with the changing practice of PCI, and despite treating sicker patients, there have been important improvements in post-PCI CABG and MI rates for women, as well as for men. Unlike in earlier years, there are no longer significant differences in outcomes by gender.
Malenka
David J
DJ
Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. david.malenka@hitchcock.org
Wennberg
David E
DE
Quinton
Hebe A
HA
O'Rourke
Daniel J
DJ
McGrath
Paul D
PD
Shubrooks
Samuel J
SJ
O'Connor
Gerry T
GT
Ryan
Thomas J
TJ
Robb
John F
JF
Kellett
Mirle A
MA
Bradley
William A
WA
Hearne
Michael A
MA
VerLee
Peter N
PN
Watkins
Matthew W
MW
Hettleman
Bruce D
BD
Piper
Winthrop D
WD
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000706:statistics & numerical data / Q000639:trends*; D001026:Coronary Artery Bypass / Q000639:trends; D003327:Coronary Disease / Q000628:therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009511:New England; D017063:Outcome Assessment, Health Care / Q000639:trends; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D015607:Stents; D016896:Treatment Outcome