title: Are there gender differences in coronary artery disease? The Malaysian National Cardiovascular Disease Database - Percutaneous Coronary Intervention (NCVD-PCI) Registry.
abstract: OBJECTIVE
  To assess whether gender differences exist in the clinical presentation, angiographic severity, management and outcomes in patients with coronary artery disease (CAD).
  
  
  METHODS
  The study comprised of 1,961 women and 8,593 men who underwent percutaneous coronary intervention (PCI) and were included in the Malaysian NCVD-PCI Registry from 2007-2009. Significant stenosis was defined as ≥70% stenosis in at least one of the epicardial vessels.
  
  
  RESULTS
  Women were significantly older and had significantly higher rates of diabetes mellitus, hypertension, chronic renal failure, new onset angina and prior history of heart failure whereas smokers and past history of myocardial infarction were higher in men. In the ST-elevation myocardial infarction (STEMI) cohort, more women were in Killip class III-IV, had longer door-to-balloon time (169.5 min. vs 127.3 min, p<0.052) and significantly longer transfer time (300.4 min vs 166.3 min, p<0.039). Overall, women had significantly more left main stem (LMS) disease (1.3% vs 0.6%, p<0.003) and smaller diameter vessels (<3.0 mm: 45.5% vs 34.8%, p<0.001). In-hospital mortality rates for all PCI, STEMI, Non-STEMI (NSTEMI) and unstable angina for women and men were 1.99% vs 0.98%, Odds ratio (OR): 2.06 (95% confidence interval (CI): 1.40 to 3.01), 6.19% vs 2.88%, OR: 2.23 (95% CI: 1.31 to 3.79), 2.90% vs 0.79%, OR: 3.75 (95% CI: 1.58 to 8.90) and 1.79% vs 0.29%, OR: 6.18 (95% CI: 0.56 to 68.83), respectively. Six-month adjusted OR for mortality for all PCI, STEMI and NSTEMI in women were 2.18 (95% CI: 0.97 to 4.90), 2.68 (95% CI: 0.37 to 19.61) and 2.66 (95% CI: 0.73 to 9.69), respectively.
  
  
  CONCLUSIONS
  Women who underwent PCI were older with more co-morbidities. In-hospital and six-month mortality for all PCI, STEMI and NSTEMI were higher due largely to significantly more LMS disease, smaller diameter vessels, longer door-to-balloon and transfer time in women.
authors.affiliation: Department of Cardiology, Sultanah Aminah Hospital, Johor Bahru, Johor, Malaysia.
authors.forename: Chuey Yan
authors.initials: CY
authors.lastname: Lee
authors.forename: Noran N
authors.initials: NN
authors.lastname: Hairi
authors.forename: Wan Azman
authors.initials: WA
authors.lastname: Wan Ahmad
authors.forename: Omar
authors.initials: O
authors.lastname: Ismail
authors.forename: Houng Bang
authors.initials: HB
authors.lastname: Liew
authors.forename: Robaayah
authors.initials: R
authors.lastname: Zambahari
authors.forename: Rosli Mohd
authors.initials: RM
authors.lastname: Ali
authors.forename: Alan Yean Yip
authors.initials: AY
authors.lastname: Fong
authors.forename: Kui Hian
authors.initials: KH
authors.lastname: Sim
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012306:Risk; D012720:Severity of Illness Index; D012727:Sex Characteristics; D017678:Sex Distribution; D016896:Treatment Outcome