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Similar 1-Year Outcomes for Women and Men After Coronary Artery Stenting

Although higher complication and lower success rates have been reported for women who undergo coronary interventions than for men, potential sex differences in outcomes after coronary artery stenting have not been examined. These investigators studied a consecutive series of 3263 men and 1001 women with stable or unstable angina who had been referred for coronary artery stenting to 2 tertiary care hospitals in Germany from May 1992 through December 1998. Patients who underwent stenting in the setting of acute MI were excluded.

Compared with male subjects, female subjects were older and more likely to be diabetic, hypertensive, and hypercholesterolemic; however, they were less likely to have multivessel disease, left ventricular systolic dysfunction, and histories of MI or bypass surgery. Disease in women was more common in the left anterior descending artery and in smaller vessels compared with disease in men. No significant sex-related differences were found for stent characteristics, procedural success, and use of adjunctive pharmacologic therapy.

During the first 30 days after stenting, the rate of the combined endpoint of death or nonfatal MI was higher among women than among men (3.1 percent vs. 1.8 percent; P=0.02; adjusted hazard ratio, 2.02; 95 percent CI, 1.27-3.19). At 1 year, however, rates were similar (6.0 percent for women, 5.8 percent for men). Coronary-vessel size did not correlate with the 30-day outcome.

Comment: The findings of this large cohort study provide new insights into the role of sex in both short- and long-term outcomes after coronary artery stenting. Although an early hazard was associated with stenting in women, 1-year outcomes were similar between sexes. This supports an approach to treatment, incorporating stenting, that is as aggressive for women with coronary artery disease as it is for men with CAD. Finally, consistent with prior results, adverse outcomes were particularly prevalent among women with diabetes; this high-risk subset may derive the greatest benefit from the use of glycoprotein IIb/IIIa inhibitors in conjunction with stenting.

— JM Foody

Published in Journal Watch Cardiology December 1, 2000

Citation(s):

Mehilli J et al. Differences in prognostic factors and outcomes between women and men undergoing coronary artery stenting. JAMA 2000 Oct 11 284 1799 -1805.

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