The Changing In-Hospital Mortality of Women Undergoing Percutaneous Transluminal Coronary Angioplasty

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.