In-hospital mortality among women undergoing contemporary elective percutaneous coronary intervention: a reexamination of the gender gap.
BACKGROUND
Previous studies have indicated that, compared with men, women are at increased risk for in-hospital mortality following percutaneous coronary intervention (PCI); however, angioplasty techniques and mortality rates have improved since earlier reports.


OBJECTIVE
We sought to reevaluate and explore further the relationship between gender and angioplasty outcomes in contemporary "real world" practice.


METHODS
The influence of gender and other covariates on in-hospital mortality and other adverse events among all patients who underwent elective coronary angioplasty in New York State from 1999 to 2001 (n = 106,262) was examined.


RESULTS
In-hospital mortality rates for elective angioplasty were low; however, women demonstrated a two-fold mortality excess compared with men (0.6 vs. 0.3%, p < 0.0001). Women were older and more likely than men to demonstrate certain higher-risk features (heart failure, class III-IV angina, renal failure, vascular disease); however, men were more likely to have depressed ejection fraction, prior myocardial infarction, and prior coronary revascularization. Using multivariate analysis adjusting for clinical risk factors, gender remained an independent predictor of in-hospital mortality at all ages. Women were also more likely to experience nonfatal adverse events following PCI, including more frequent need for emergency bypass surgery.


CONCLUSIONS
Despite improvements in angioplasty outcomes with time, women remain at significantly higher risk of in-hospital death than men after elective PCI. This increased mortality is observed in every age group, even after adjusting for other significant comorbidities.
Narins
Craig R
CR
Division of Cardiology, Department of Medicine, The University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. craig_narins@urmc.rochester.edu
Ling
Frederick S
FS
Fischi
Michael
M
Peterson
Derick R
DR
Bausch
Janice
J
Zareba
Wojciech
W
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000401:mortality*; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D012737:Sex Factors; D016896:Treatment Outcome