Comparison of outcomes in women and men treated with coronary stent implantation.
Worse outcomes have been observed in women after PTCA. The present study was undertaken to compare clinical and angiographic results of coronary stenting among women and men. We retrospectively analyzed acute and 6-month results in a consecutive series of 940 men and 160 women undergoing coronary stent implantation between May 1992 and January 1998. Women were older (63 vs. 57 years; P = 0.001), more often hypertensive (46.9% vs. 31.4%; P < 0.001) and diabetic (13.2% vs. 8.3%; P = 0.05), and less often smokers than men (32.5% vs. 70.5%; P < 0.001). A previous history of Q-wave MI was less frequently present in women (28.2% vs. 40.2%; P = 0.003) who more often underwent coronary revascularization because of unstable angina (37.5% vs. 27.1%; P = 0.027). No difference was observed in coronary artery disease extension, lesion complexity, and stented vessel between the sexes. Bailout stenting was more frequently needed in women (28% vs. 17.8%; P = 0.001). No difference was observed in the number of stent implanted per vessel and per patient and average maximal inflation pressure used for stent postdilation. However, a smaller final balloon size was used in women. Procedural and clinical success was achieved in 94.4% and 92.5% of women and 96.7% and 94.5% of men (P = NS), respectively, without differences regarding in-hospital major adverse cardiac events. Bleeding complications occurred more often in women when anticoagulation was used (OR = 2.87; 95% CI = 1.38-5.74). At 6-month clinical follow-up, TLR was similar between the sexes and event-free survival was 75.5% in women and 81.5% in men (P = NS). Angiographic follow-up, performed in 71% of the patients, showed that restenosis was 64% higher in women (OR = 1.64; 95% CI = 1.02-2.61). Despite older age, higher incidence of comorbidities, and more unstable presentation, women treated with coronary stenting showed acute and mid-term clinical results similar to those observed in men. However, they were significantly more likely to develop angiographic restenosis.
Trabattoni
Daniela
D
Istituto di Cardiologia, Centro Cardiologico "Monzino," IRCCS, Milan, Italy.
Bartorelli
Antonio L
AL
Montorsi
Piero
P
Fabbiocchi
Franco
F
Loaldi
Alessandro
A
Galli
Stefano
S
Ravagnani
Paolo
P
Cozzi
Sergio
S
Grancini
Luca
L
Liverani
Antonio
A
Leon
Maria E
ME
Robertson
Chris
C
Boyle
Peter
P
D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D012737:Sex Factors; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors