Elsevier

American Heart Journal

Volume 157, Issue 1, January 2009, Pages 141-148
American Heart Journal

Clinical Investigation
Interventional Cardiology
Gender differences among patients with acute coronary syndromes undergoing percutaneous coronary intervention in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR)

https://doi.org/10.1016/j.ahj.2008.08.012Get rights and content

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.

Section snippets

Data collection

The American College of Cardiolology-National Cardiovascular Data Registry (ACC-NCDR) is a national cardiac catheterization laboratory registry. Hospitals performing cardiac catheterization and PCI procedures voluntarily participate in data collection. Data are collected retrospectively or concurrently and represent consecutive patients treated at each institution. A standardized set of data elements and definitions, systematic data entry, and transmission procedures are used to ensure rigorous

Clinical characteristics

A total of 199,690 patients, 131,664 men and 68,026 women, met the inclusion criteria for this study. Of these, 157,652 patients presented with UA/NSTEMI and 42,038 patients presented with STEMI. A significant difference in presenting diagnosis based on gender was observed where a higher proportion of women presented with UA/NSTEMI than men (82% of women vs 77% of men, P < .01). Women were older than men whether presenting with UA/NSTEMI or STEMI (Table I). Most patients were white (87%).

In

Discussion

The ACC-NCDR reflects treatment patterns across the United States and affords an analysis of contemporary management of ACS patients undergoing PCI in the DES era. Our results demonstrate gender differences in clinical presentation, angiographic features, administration of antiplatelet therapies, and higher procedural complications in women with ACS who had a PCI during admission. Many of these differences persisted despite adjustment for baseline risk factors.

Women present significantly more

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  • Cited by (0)

    Dr. W. Douglas Weaver served as guest editor for this manuscript.

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