ORLANDO — Women undergoing primary angioplasty for acute MI continue to have significantly higher mortality than men, even in the contemporary era of potent antiplatelet therapy regimens and high-pressure stent deployment, according to a large and comprehensive patient series from the New York State Coronary Angioplasty Reporting System Registry.
In a cohort of 9,015 consecutive acute MI patients—29% of them women—who underwent primary percutaneous coronary intervention (PCI) in New York state during 1997–1999, unadjusted in-hospital mortality was 6.7% in women and 3.4% in men. Mean hospital length of stay was also significantly greater in the women: 7.5 days, compared with 6 days for men, Jeffrey S. Berger, M.D., reported at the annual meeting of the American College of Cardiology.
The composite major adverse cardiovascular event rate—comprising death, emergency coronary artery bypass surgery, catheter-site complications, need for renal dialysis, stroke, abrupt vessel closure, or stent thrombosis—was 10% in women, compared with 5.7% in men, added Dr. Berger of Beth Israel Medical Center, New York.
However, women as a group were at higher risk of complications related to urgent PCI than were men. They were significantly older, by a mean of nearly 7 years. They also had higher prevalences of diabetes, hypertension, and peripheral vascular disease and were more likely to have a history of stroke.
Yet even after adjusting for all of these potential confounders in a multivariate logistic regression analysis, investigators still found female gender remained a strong independent risk factor for adverse outcome, with an associated 42% increased relative risk of in-hospital mortality.
A major caveat regarding the state registry is that the data are nonrandomized and retrospective, so it's possible that significant differences between men and women undergoing primary PCI for MI remain uncontrolled for and unrecognized.