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Short- and Long-Term Outcomes of Coronary Stenting in Women Versus Men: Results From the National Cardiovascular Data Registry Centers for Medicare & Medicaid Services Cohort
Study Questions:
Do outcomes after coronary stenting differ by sex?
Methods:
Data from the National Cardiovascular Data Registry CathPCI Registry (2004-2008) were linked to Medicare inpatient claims data, to include men and women ages 65 years or older. The National Cardiovascular Data Registry (NCDR) CathPCI Registry collects information on patient and hospital characteristics, clinical presentation, treatments, and in-hospital outcomes for percutaneous coronary intervention (PCI) procedures from >1,000 participating sites across the United States. CathPCI Registry stent procedures between January 1, 2004, and December 31, 2008, were linked to Medicare’s 100% inpatient fee-for-service claims files using indirect identifiers (e.g., index PCI procedure site, patient date of birth or age, admission, discharge date, and sex). Patients who did match to the Medicare records or who received both a bare-metal stent and drug-eluting stent were excluded. Outcomes examined included in-hospital events and long-term events.
Results:
In this analysis, longitudinal profiles were created with up to 62.7 months of patient follow-up (median, 20.4 months; 25th percentile, 9.1 months; 75th percentile, 32.8 months). Data on 426,996 patients from the CathPCI Registry were linked to Medicare inpatient claims to compare in-hospital outcomes by sex, and long-term outcomes by sex and stent type. In-hospital complications were more frequent in women than in men, including death (adjusted odds ratio [OR], 1.41; 95% confidence interval [CI], 1.33-1.49), myocardial infarction (OR, 1.19; 95% CI, 1.11-1.27), bleeding (OR, 1.86; 95% CI, 1.79-1.93), and vascular complications (OR, 1.85; 95% CI, 1.73-1.99). At 20.4 months, women had a lower adjusted risk of death (hazards ratio [HR], 0.92; 95% CI, 0.90-0.94), but similar rates of myocardial infarction, revascularization, and bleeding compared to men. Relative to bare-metal stent use, drug-eluting stent use was associated with similar improved long-term outcomes in both sexes: death (women: adjusted HR, 0.78; 95% CI, 0.76-0.81; men: HR, 0.77; 95% CI, 0.74-0.79), myocardial infarction (women: HR, 0.79; 95% CI, 0.74-0.84; men: HR, 0.81; 95% CI, 0.77-0.85), and revascularization (women: HR, 0.93; 95% CI, 0.90-0.97; men: HR, 0.91; 95% CI, 0.88-0.94). No interaction between sex and stent type was observed for long-term outcomes.
Conclusions:
The investigators concluded that coronary stenting in women may be associated with a slightly higher procedural risk compared to men; however, long-term survival was better among women. In both men and women, drug-eluting stents were associated with lower long-term risk including outcomes such as death, myocardial infarction, and revascularization.
Perspective:
This large-scale analysis supports the use of drug-eluting stents in both men and women, although women appear to have slightly higher risk for in-hospital events, particularly bleeding and vascular complications. Unfortunately, these data are limited to patients over the age of 65 years. Prior studies have observed higher adverse event rates among younger women; thus, ability to look at an interaction between age and sex would be informative.
Keywords: Survivors, Risk, Myocardial Infarction, Follow-Up Studies, Drug-Eluting Stents, Medicare, Angioplasty, Balloon, Coronary, United States, Stents, Percutaneous Coronary Intervention
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