Women had higher 30-day mortality after PCI (HRs 1.12–1.27), but lower 1-year mortality in elective (HR 0.90) and NSTEMI PCI (HR 0.91); STEMI 1-year mortality difference was not significant.
Does female sex affect short- and long-term mortality in patients undergoing percutaneous coronary intervention?
Women undergoing PCI have higher 30-day mortality than men across all indications, but exhibit lower 1-year mortality following elective and NSTEMI PCI.
Absolute Event Rate: 0% vs 0%
Abstract Background - Coronary artery disease is the leading cause of death worldwide. Studies on sex differences in percutaneous coronary intervention (PCI) outcomes show conflicting results due to selective populations, single-center data, or lack of stratification by indication. Large-scale real-world data are needed for clearer insights. Purpose - This study examines sex-based differences in short- and long-term mortality after PCI, stratified by indication (elective, NSTEMI, STEMI), using nationwide data from the Netherlands Heart Registration (NHR). Results – A total of 221,798 patients were included, of whom 28% were women. On average, women were older (69.5 years vs. 65.3 years, p0.001) and had higher rates of preserved left ventricular ejection fraction (LVEF 50%; 28.9% vs. 26.3%, p0.001), renal dysfunction (eGFR 30 ml/min; 3% vs. 2.1%, p0.001), and diabetes (23% vs. 19.5%, p0.001). However, they had lower rates of multi-vessel disease (43.6% vs. 49.9%, 0.001), prior myocardial infarction (11.1% vs. 14.6%, p0.001), and out-of-hospital cardiac arrest (2.5% vs. 4.1%, p0.001). Overall, women had higher unadjusted mortality at 30 days (3.2% vs. 2.5%, p0.001), as well as at one year (6.3% vs. 5.3%, p0.001). Kaplan-Meier analysis showed significantly lower 30-day event-free survival for women across all PCI indications (p0.001). After multivariate adjustment, female sex remained an independent predictor of 30-day mortality for elective PCI (HR 1.26, 95% CI 1.04–1.54, p=0.02), NSTEMI PCI (HR 1.27, 95% CI 1.11–1.44, p0.001), and STEMI PCI (HR 1.12, 95% CI 1.03–1.21, p=0.005). However, at one year, women had significantly lower 1-year mortality in elective PCI (HR 0.90, 95% CI 0.84-1.00, p=0.03) and NSTEMI PCI (HR 0.91, 95% CI 0.84-0.99, p=0.04). In STEMI PCI, women still had higher 1-year mortality, but this was no longer statistically significant after adjustment (HR 1.07, 95% CI 1.00-1.14, p=0.06). Conclusions - Women undergoing PCI have higher short-term mortality than men, but at one year, women showed lower mortality in elective and NSTEMI PCI, while STEMI mortality remained higher, though not statistically significant. Future studies should investigate the factors behind these short- and long-term mortality discrepancies, especially the improved outcomes in elective and NSTEMI PCI and the persistent survival disadvantage in STEMI.Graphical abstract
Ricken et al. (Sat,) reported a other. Women had higher 30-day mortality after PCI (HRs 1.12–1.27), but lower 1-year mortality in elective (HR 0.90) and NSTEMI PCI (HR 0.91); STEMI 1-year mortality difference was not significant.