Sex Differences in Percutaneous Coronary Intervention-Insights From the Coronary Angiography and PCI Registry of the German Society of Cardiology.
BACKGROUND
Several studies have suggested sex-related differences in diagnostic and invasive therapeutic coronary procedures.


RESULTS
Data from consecutive patients who were enrolled in the Coronary Angiography and PCI Registry of the German Society of Cardiology were analyzed. We aimed to compare sex-related differences in in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease, non-ST elevation acute coronary syndromes, ST elevation myocardial infarction, and cardiogenic shock. From 2007 until the end of 2009 data from 185 312 PCIs were prospectively registered: 27.9% of the PCIs were performed in women. Primary PCI success rate was identical between the sexes (94%). There were no sex-related differences in hospital mortality among patients undergoing PCI for stable coronary artery disease, non-ST elevation acute coronary syndromes, or cardiogenic shock except among ST elevation myocardial infarction patients. Compared to men, women undergoing primary PCI for ST elevation myocardial infarction have a higher risk of in-hospital death, age-adjusted odds ratio (1.19, 95% CI 1.06-1.33), and risk of ischemic cardiac and cerebrovascular events (death, myocardial infarction, transient ischemic attack/stroke), (age-adjusted odds ratio 1.19, 95% CI 1.16-1.29). Furthermore, access-related complications were twice as high in women, irrespective of the indication.


CONCLUSIONS
Despite identical technical success rates of PCI between the 2 sexes, women with PCI for ST elevation myocardial infarction have a 20% higher age-adjusted risk of death and of ischemic cardiac and cerebrovascular events. Further research is needed to determine the reasons for these differences.
Klinikum München Schwabing, Academic Teaching Hospital, University of Munich, Germany tobias.heer@klinikum-muenchen.de.
Tobias
T
Heer
Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
Matthias
M
Hochadel
Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
Karin
K
Schmidt
Medizinische Klinik I, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
Julinda
J
Mehilli
Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
Ralf
R
Zahn
Asklepios Klinik St. Georg Hamburg, Hamburg, Germany.
Karl-Heinz
KH
Kuck
Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Germany.
Christian
C
Hamm
Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Michael
M
Böhm
Medizinische Klinik und Poliklinik I/Comprehensive Heart Failure Center, Universitätsklinikum Würzburg, Würzburg, Germany.
Georg
G
Ertl
Städtisches Klinikum Solingen, Solingen, Germany.
Hans Martin
HM
Hoffmeister
Klinikum München Schwabing, Academic Teaching Hospital, University of Munich, Germany.
Stefan
S
Sack
Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
Jochen
J
Senges
Medizinische Klinik I, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
Steffen
S
Massberg
Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.|Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
Anselm K
AK
Gitt
Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.|Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
Uwe
U
Zeymer
D054058:Acute Coronary Syndrome / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D002309:Cardiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000601:surgery*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012042:Registries; D000072657:ST Elevation Myocardial Infarction / Q000601:surgery*; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000601:surgery*; D012955:Societies, Medical
acute coronary syndrome; angioplasty and stenting; coronary artery disease; outcome; women