Key result
In-hospital mortality after PTCA was higher in women than men (4.2% vs 2.7%, P=0.005), but this difference was primarily related to baseline disease severity and body surface area rather than gender.
Why the study?
Does female gender affect in-hospital mortality in patients undergoing percutaneous transluminal coronary angioplasty?
Cohort (n=3,557)
No
Does female gender affect in-hospital mortality in patients undergoing percutaneous transluminal coronary angioplasty?
Effect estimate: OR 1.51 (95% CI 1.00 to 2.29)
Absolute Event Rate: 4.2% vs 2.7%
p-value: p=0.05
Higher in-hospital mortality among women undergoing PTCA compared to men is primarily driven by greater baseline disease severity and smaller body surface area rather than gender itself.
Risk after PTCA should not be attributed to gender alone; leaves open whether body surface area and severity drive outcomes in women.
Objective. —To compare in-hospital mortality among women and men undergoing percutaneous transluminal coronary angioplasty (PTCA) and determine whether mortality differences have changed recently. Design. —A retrospective cohort study. Setting. —Tertiary referral institution. Patients. —Consecutive series of 3557 patients (27% women) who underwent 4071 PTCA procedures. Two cohorts were analyzed: patients treated between 1979 and 1987 (n=1970) and those treated between 1988 and 1990 (n=2101). Main Outcome Measures. —In-hospital and periprocedural mortality. Results. —Women were older than men (P<.001) and more had class III or IV angina(P<.001), unstable angina(P<.001), angina at rest (P<.001), cardiac failure (P<.001), and diabetes mellitus, hypertension, and hypercholesterolemia (P<.001). The PTCA was successful in 85% of women and 86% of men with an in-hospital mortality rate of 4.2% and 2.7%, respectively (P=.005). No significant change in mortality occurred in men between the early (2.2%) and late (3.1%) eras in contrast to a significant increase among women, 2.9% to 5.4% (P=.04). Periprocedural mortalities for women and men between 1979 and 1987 were 1.0% and 1.2% (P=not significant) and between 1988 and 1990 were 2.9% and 1.4% (P=.02), respectively. The multivariate odds ratio of in-hospital mortality for women vs men was 1.51 (95% confidence interval, 1.00 to 2.29;P=.05), although six other baseline variables were more powerful predictors of in-hospital mortality. Accounting for body surface area resulted in no significant association between gender and in-hospital mortality. Periprocedural mortality was not independently associated with gender. Conclusions. —In-hospital mortality among women has increased in recent years, but their higher mortality compared with men is related more to the severity of their underlying disease rather than gender alone. (JAMA. 1993;269:2091-2095)
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M. R. Bell (1993) conducted a cohort in Undergoing percutaneous transluminal coronary angioplasty (PTCA) (n=3,557). Female gender vs. Male gender was evaluated on In-hospital mortality (OR 1.51, 95% CI 1.00 to 2.29, p=0.05). In-hospital mortality after PTCA was higher in women than men (4.2% vs 2.7%, P=0.005), but this difference was primarily related to baseline disease severity and body surface area rather than gender.
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