Key result
After propensity matching, women had a lower 5-year risk of all-cause death after percutaneous coronary intervention compared to men (20.2% vs 26.1%; HR 0.75, 95% CI 0.71-0.78).
Why the study?
Sex-specific outcomes after percutaneous coronary intervention are not consistent among studies.
Does female sex affect the 5-year cumulative incidence of all-cause death in patients undergoing PCI compared to male sex?
Cohort (n=48,783)
Yes
Does female sex affect the 5-year cumulative incidence of all-cause death in patients undergoing PCI compared to male sex?
Hazard Ratio: 0.75 (95% CI 0.71–0.78)
Absolute Event Rate: 20.2% vs 26.1%
Although women appear to have worse unadjusted outcomes after PCI due to older age and more comorbidities, propensity-matched analysis reveals they actually have a lower 5-year mortality risk than men.
Adjusted analysis links female sex to lower post-PCI mortality; leaves open whether findings extend beyond this cohort or warrant sex-specific risk models.
OBJECTIVE: We investigated the gender difference in the 5-year outcome after percutaneous coronary intervention (PCI) using an unselected population data. BACKGROUND: Sex-specific outcome after percutaneous coronary intervention (PCI) is not consistent among studies. METHODS: A total of 48,783 patients were enrolled from a Korean nationwide cohort of PCI in year 2011. Outcomes adjusted with age and propensity for clinical characteristics were compared. Primary outcome was 5-year cumulative incidence of all-cause death. Nonfatal major adverse clinical event (MACE) consisting of revascularization, shock, or stroke was also assessed. RESULTS: In unadjusted analysis, women were older and had higher frequency of comorbidities including hypertension, hyperlipidemia, and diabetes compared to men (p < .001, all). Women had higher 5-year death risk than men (21.8 vs. 17.3%; hazard ratio [HR] 1.29, 95% confidential interval [CI] 1.23-1.34). In propensity score-matched analysis (N = 28,924), women had lower 5-year death risk (20.2 vs. 26.1%, HR 0.75, 95% CI 0.71-0.78). This lower death risk in women was consistent in subgroup analyses of age, risk factors, and clinical diagnosis including angina or acute myocardial infarction (p < .05, all). CONCLUSIONS: Older age and more common comorbidities in women contributed to the apparent worse outcome after PCI in women. After adjusting these disadvantages, women had better outcome after PCI than men.
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Lee et al. (2021) conducted a cohort in Percutaneous coronary intervention (PCI) (n=48,783). Female sex vs. Male sex was evaluated on 5-year cumulative incidence of all-cause death (HR 0.75, 95% CI 0.71-0.78). After propensity matching, women had a lower 5-year risk of all-cause death after percutaneous coronary intervention compared to men (20.2% vs 26.1%; HR 0.75, 95% CI 0.71-0.78).
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