Gender differences among patients with acute coronary syndromes undergoing percutaneous coronary intervention in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR)
Received 20 June 2008; accepted 12 August 2008.
Background
Although prior studies have demonstrated disparities in the management and outcomes of women with acute coronary syndrome (ACS), there are limited large-scale contemporary data on gender differences in post-intervention outcomes in this population.
Methods
We analyzed patients according to 2 ACS categories, unstable angina/non–ST-elevation myocardial infarction (UA/NSTEMI) and ST-elevation myocardial infarction (STEMI) who had a percutaneous coronary intervention in the ACC-NCDR from January 1, 2004, to March 30, 2006. Of 199,690 patients, 55,691 women presented with UA/NSTEMI, and 12,335 women presented with STEMI. Clinical and angiographic characteristics, procedural and treatment patterns, and in-hospital outcomes were examined.
Results
Women presented more often with UA/NSTEMI than men (82% of women vs 77% of men, P < .0001). Despite having greater comorbidities, women in both ACS categories had fewer high risk angiographic features than men. Women were less likely to receive aspirin or glycoprotein IIb/IIIa inhibitors, and were less often discharged on aspirin or statin. For in-hospital mortality, the adjusted odds ratio for men compared to women was similar (odds ratio 0.97, P = .5). Women had higher rates of cardiogenic shock, congestive heart failure, any bleeding, and any vascular complications. Importantly, rates of subacute stent thrombosis were less in women compared to men (0.43% vs 0.57%, P = .0003).
Conclusions
Although women had fewer high-risk angiographic features than men, they continue to have higher rates of in-hospital complications. This suggests the need for gender-tailored techniques to minimize post-intervention complications and maximize application of evidence-based antiplatelet therapies.
aDivision of Cardiology, University of Illinois at Chicago Medical Center, Chicago, IL
bDuke Clinical Research Institute, Duke University Medical Center, Durham, NC
cVanderbilt University Medical Center, Nashville, TN
Reprint requests: Adhir Shroff, MD, MPH, Division of Cardiology, University of Illinois at Chicago Medical Center, 840 S. Wood Street Suite 926, M/C 715, Chicago, IL 60612.
Dr. W. Douglas Weaver served as guest editor for this manuscript.
ABSTRACT