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Gender and Long-Term Outcome After Bare-Metal Stents
Study Questions:
Does gender impact long-term outcome of patients undergoing percutaneous coronary intervention (PCI) with bare-metal stents (BMS)?
Methods:
The authors evaluated the impact of gender on outcome of patients undergoing BMS PCI and followed in the CREDO-Kyoto registry for over 10 years. This multicenter registry enrolled patients undergoing their first PCI or coronary artery bypass graft surgery between January 2000 and December 2002.
Results:
The study population included 5,313 patients who underwent BMS, and of these, 3,742 were male and 1,571 were women. Follow-up at 10 years was completed in 4,515 patients (85.0%). The cumulative incidence of target lesion revascularization (TLR) was 27% at 1 year, and 34% at 10 years. The annualized TLR rate beyond 1 year was 0.8%/year. Patients were more likely to require revascularization for lesions other than the index culprit on long-term follow-up, with a rate of 13% at 1 year, and 31% at 10 years (2.0%/year beyond 1 year). Cumulative incidence of stent thrombosis was 1.2% at 1 year, and 1.9% at 10 years. Women were older and had greater prevalence of cardiovascular risk factors than men. Men were more likely to have a higher cumulative 10-year incidence of TLR (36% vs. 30%, p < 0.001, adjusted hazard ratio, 1.29; 95% confidence interval, 1.15-1.46; p < 0.001). Male gender was associated with significantly higher adjusted risks for all-cause death, myocardial infarction, stroke, and revascularization.
Conclusions:
There is a small, but steady risk of TLR over the long-term in both men and women undergoing PCI with BMS, but this is higher in men than women.
Perspective:
This study provides an important context to the long-term outcome of patients treated with BMS. It is interesting that the risk of TLR, although low, did not attenuate beyond the first year, although stent thrombosis was exceedingly uncommon after year 1. These data will serve as an important context to the next generation of drug-eluting stents (DES) that are being tested where some have a biodegradable polymer; the expectation is that the stent would behave like a BMS over the long-term. Similar studies are needed to evaluate the long-term efficacy of contemporary DES so that subtle differences in low frequency events on follow-up can be defined.
Keywords: Coronary Artery Disease, Coronary Restenosis, Drug-Eluting Stents, Myocardial Infarction, Myocardial Revascularization, Outcome Assessment, Health Care, Percutaneous Coronary Intervention, Risk Factors, Stents, Stroke, Thrombosis
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