Differences in outcomes between women and men associated with percutaneous transluminal coronary angioplasty. A regional prospective study of 13,061 procedures. Northern New England Cardiovascular Disease Study Group.

Abstract

A prospective study of patients undergoing percutaneous transluminal coronary angioplasty was conducted to examine differences in mortality and nonfatal outcomes by sex. Data were collected on 12,232 patients representing 13,061 trips to the catheterization laboratory for percutaneous transluminal coronary angioplasty (PTCA) of 17,096 lesions between 1989 and 1993. Differences in patient characteristics, comorbidities, severity of illness, and treatments were examined and crude and adjusted odds ratios (ORs) for women versus men reported. Rates of success, fatal and nonfatal outcomes, ORs, and 95% Cls were calculated. Clinical success for women (88.8%) and men (87.9%) was good and comparable. Mortality rates for women (1.64%) and men (0.7%) differed, with an OR (women versus men) of 2.34 (95% CI, 1.64, 3.35). Nonfatal adverse outcomes rates (coronary artery bypass grafting and myocardial infarction) for women (5.29%) and for men (4.29%) were of borderline significance, with an OR of 1.19 (95% CI, 1.00, 1.41). Women were older, were more likely to be hypertensive and diabetic, and had more urgent and emergent procedures. For mortality, the adjusted OR (women versus men) was 1.64 (95% CI, 1.09, 2.47), and for nonfatal adverse outcomes, the OR was 1.14 (95% CI, 0.95, 1.36). Although the success rate of PTCA for men and women is comparable, women are at higher risk for adverse outcomes. For nonfatal events, the excess risk-is attributable to differences in case mix. For death, the risk remains elevated even after adjusting for case mix.