title: Sex Differences in Outcomes Following Percutaneous Coronary Intervention According to Age.
abstract: BACKGROUND
  Women <50 years of age with coronary artery disease may represent a group at higher risk for recurrent ischemic events after percutaneous coronary intervention (PCI); however, no long-term, multicenter outcomes assessment exists in this population.
  
  
  RESULTS
  Using the National Heart, Lung, and Blood Institute Dynamic Registry, we evaluated the association of sex and age on cardiovascular-related outcomes in 10,963 patients (3797 women, 394 <50 years) undergoing PCI and followed for 5 years. Death, myocardial infarction, coronary artery bypass graft surgery, and repeat PCI were primary outcomes comprising major adverse cardiovascular events. Although procedural success rates were similar by sex, the cumulative rate of major adverse cardiovascular events at 1 year was higher in young women (27.8 versus 19.9%; P=0.003), driven largely by higher rates of repeat revascularizations for target vessel or target lesion failure (coronary artery bypass graft surgery: 8.9% versus 3.9%, P<0.001, adjusted hazard ratio 2.4, 95% confidence interval 1.5-4.0; PCI: 19.0% versus 13.0%, P=0.005, adjusted hazard ratio 1.6, 95% confidence interval 1.2-2.2). At 5 years, young women remained at higher risk for repeat procedures (coronary artery bypass graft surgery: 10.7% versus 6.8%, P=0.04, adjusted hazard ratio 1.71, 95% confidence interval 1.01-2.88; repeat PCI [target vessel]: 19.7% versus 11.8%, P=0.002, adjusted hazard ratio 1.8, 95% confidence interval 1.24-2.82). Compared with older women, younger women remained at increased risk of major adverse cardiovascular events, whereas all outcome rates were similar in older women and men.
  
  
  CONCLUSIONS
  Young women, despite having less severe angiographic coronary artery disease, have an increased risk of target vessel and target lesion failure. The causes of this difference deserve further investigation.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005677.
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.); Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.); Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.); Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.); Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.); Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.); and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.).
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Epps
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.); Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.); Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.); Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.); Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.); Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.); and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.).
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Holper
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.); Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.); Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.); Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.); Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.); Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.); and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.).
authors.forename: Faith
authors.initials: F
authors.lastname: Selzer
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.); Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.); Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.); Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.); Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.); Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.); and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.).
authors.forename: Helen A
authors.initials: HA
authors.lastname: Vlachos
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.); Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.); Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.); Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.); Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.); Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.); and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.).
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Gualano
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.); Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.); Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.); Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.); Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.); Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.); and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.).
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Abbott
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.); Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.); Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.); Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.); Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.); Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.); and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.).
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.); Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.); Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.); Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.); Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.); Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.); and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.).
authors.forename: Oscar C
authors.initials: OC
authors.lastname: Marroquin
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.); Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.); Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.); Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.); Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.); Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.); and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.).
authors.forename: Srihari S
authors.initials: SS
authors.lastname: Naidu
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.); Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.); Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.); Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.); Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.); Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.); and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.).
authors.forename: Peter W
authors.initials: PW
authors.lastname: Groeneveld
authors.affiliation: From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, and Cardiovascular Institute, University of Pennsylvania, Philadelphia (K.C.E., R.L.W.); Department of Medicine, Division of Cardiology, Medical City Hospital, Dallas, TX (E.M.H.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (F.S., H.A.V.); Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (S.K.G.); Department of Medicine, Rhode Island Hospital, Cardiovascular Institute, Providence, RI (J.D.A.); Department of Medicine, Section of Cardiology, Boston University Medical Center, MA (A.K.J.); Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA (O.C.M.); Department of Medicine, Division of Cardiology, Winthrop University Hospital, Mineola, NY (S.S.N.); and Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Michael J. Crescenz VA Medical Center, Philadelphia (P.W.G.).
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wilensky
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003324:Coronary Artery Disease / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D012307:Risk Factors; D012727:Sex Characteristics
keywords: acute coronary syndrome; myocardial infarction; restenosis; revascularization