Judith H Lichtman1, Yongfei Wang2, Sara B Jones3, Erica C Leifheit-Limson3, Leslee J Shaw4, Viola Vaccarino4, John S Rumsfeld5, Harlan M Krumholz6, Jeptha P Curtis7. 1. Yale School of Public Health, New Haven, CT; Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, CT. Electronic address: Judith.Lichtman@yale.edu. 2. Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, CT. 3. Yale School of Public Health, New Haven, CT. 4. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. 5. Denver VA Medical Center, Denver, CO. 6. Yale School of Public Health, New Haven, CT; Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, CT; Yale School of Medicine, New Haven, CT. 7. Yale-New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, CT; Yale School of Medicine, New Haven, CT.
Abstract
BACKGROUND: Older women experience higher complication rates and mortality after percutaneous coronary intervention (PCI) than men, but there is limited evidence about sex-based differences in outcomes among younger patients. We compared rates of complications and inhospital mortality by sex for younger and older PCI patients. METHODS: A total of 1,079,751 hospital admissions for PCI were identified in the CathPCI Registry(®) from 2005 to 2008. Complication rates (general, bleeding, bleeding with transfusion, and vascular) and inhospital mortality after PCI were compared by sex and age (<55 and ≥55 years). Analyses were adjusted for demographic and clinical factors and stratified by PCI type (elective, urgent, or emergency). RESULTS: Overall, 6% of patients experienced complications, and 1% died inhospital. Unadjusted complication rates were higher for women compared with men in both age groups. In risk-adjusted analyses, younger women (odds ratio 1.24, 95% CI 1.16-1.33) and older women (1.27, 1.09-1.47) were more likely to experience any complication than similarly aged men. The increased risk persisted across complication categories and PCI type. Within age groups, risk-adjusted mortality was marginally higher for young women (1.19, 1.00-1.41), but not for older women (1.03, 0.97-1.10). In analyses stratified by PCI type, young women had twice the mortality risk after an elective procedure as young men (2.04, 1.15-3.61). CONCLUSIONS: Women, regardless of age, experience more complications after PCI than men; young women are at increased mortality risk after an elective PCI. Identifying strategies to reduce adverse outcomes, particularly for women younger than 55 years, is important.
BACKGROUND: Older women experience higher complication rates and mortality after percutaneous coronary intervention (PCI) than men, but there is limited evidence about sex-based differences in outcomes among younger patients. We compared rates of complications and inhospital mortality by sex for younger and older PCI patients. METHODS: A total of 1,079,751 hospital admissions for PCI were identified in the CathPCI Registry(®) from 2005 to 2008. Complication rates (general, bleeding, bleeding with transfusion, and vascular) and inhospital mortality after PCI were compared by sex and age (<55 and ≥55 years). Analyses were adjusted for demographic and clinical factors and stratified by PCI type (elective, urgent, or emergency). RESULTS: Overall, 6% of patients experienced complications, and 1% died inhospital. Unadjusted complication rates were higher for women compared with men in both age groups. In risk-adjusted analyses, younger women (odds ratio 1.24, 95% CI 1.16-1.33) and older women (1.27, 1.09-1.47) were more likely to experience any complication than similarly aged men. The increased risk persisted across complication categories and PCI type. Within age groups, risk-adjusted mortality was marginally higher for young women (1.19, 1.00-1.41), but not for older women (1.03, 0.97-1.10). In analyses stratified by PCI type, young women had twice the mortality risk after an elective procedure as young men (2.04, 1.15-3.61). CONCLUSIONS:Women, regardless of age, experience more complications after PCI than men; young women are at increased mortality risk after an elective PCI. Identifying strategies to reduce adverse outcomes, particularly for women younger than 55 years, is important.
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