Article

Impact of gender on in-hospital percutaneous coronary interventional outcomes in African-Americans

Division of Cardiology, Department of Medicine, State University of New York, Downstate Medical Center, New York, USA.
The Journal of invasive cardiology (Impact Factor: 0.95). 04/2007; 19(3):123-8.
Source: PubMed

ABSTRACT

Previous studies on outcomes following percutaneous coronary intervention (PCI) have shown an increased rate of in-hospital mortality and vascular complications in women compared to men. The impact of gender on post-PCI outcomes in African-Americans has not been reported.
We retrospectively analyzed 835 consecutive African-American patients (n = 392 men and n = 443 women) who underwent PCI using a glycoprotein IIb/IIIa inhibitor (GPI) bolus-only strategy from January 2003 to August 2004 at a single institution. Baseline characteristics, procedural data, and in-hospital outcomes were recorded.
Women were older and had a higher mean body mass index (BMI) compared to men. Men were more likely to be smokers, more often had triplevessel disease and left ventricular dysfunction compared to women. There were no deaths or repeat revascularizations in either group. After adjustment for baseline risk factors and procedural characteristics, there was no significant difference in the composite endpoint of in-hospital death, myocardial infarction (MI), and repeat revascularization between men and women (6.38% in men and 2.48% in women; p = 0.051), but women had a higher rate of major and minor bleeding (0.5 vs. 2.5; p = 0.019; and 0.5 vs. 2.3; p = 0.021, respectively). On multiple logistic regression analysis, female gender was an independent risk factor for bleeding post-PCI (adjusted odds ratio [OR]-5.6, 95% confidence intervals [CI]: 1.15-27.45).
Although there is no difference in the in-hospital composite endpoint of death, MI, and repeat revascularization, African-American women are at increased risk for bleeding complications post-PCI, even when a GPI bolus-only strategy is used.

Full-text preview

Available from: marmur.com
  • [Show abstract] [Hide abstract] ABSTRACT: The aim of the study was to compare the course of myocardial infarction in women versus men in Upper Silesia, an industrial region in the south of Poland. The study comprised 1003 patients with either ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). The patients were divided into group 1 (300 females) and group 2 (control, 703 males). The groups differed significantly with respect to age, incidence of hypertension, diabetes, and smoking. In group 1 STEMI occurred significantly less frequently than NSTEMI. Taking this into account, we divided the studied cohort into group A (STEMI patients) and group B (NSTEMI patients), each subdivided into women and men. In the 30 day long follow-up, group 1 patients had significantly lower creatine kinase activity, higher occurrence of ventricular tachycardia, lower percentage of intra-aortic balloon pump use, and longer hospital stay compared with group 2. Group 1 was characterized by significantly higher mortality and target lesion reocclusion (TLR). The medical course of myocardial infarction in women is similar to that in men, as is the treatment of acute coronary syndrome. In our study, patients from both groups underwent invasive examination with consecutive interventional treatment with similar frequency. However, this finding is not reflected in the outcomes. Women had higher risks of death and TLR in 30 day follow-up. Taking this into consideration, we should attempt to identify the factors responsible for this situation by expanding the analysis to a larger population to allow firm conclusions to be drawn.
    No preview · Article · Nov 2009 · International Heart Journal
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives: To study the frequency of bleeding and associated risk factors among patients undergoing Percutaneous Coronary Intervention (PCI). Methodology: This cross-sectional study was conducted on 500 consecutive patients, who underwent PCI at Punjab Institute of Cardiology, Lahore. Bleeding was defined according to REPLACE - 2 criteria. Results: There were 82 females (16.4%) and 418 males (83.6%); mean age 53.4 (± 9.6 years). Bleeding complications occurred in 6.2% (n=31) of patients; major bleed 0.8% (n= 4) and minor bleed 5.6% (n= 27). One patient with major bleed (retroperitoneal) died in hospital. The frequency of bleeding complications was 8.5% among females and 5.7% among males (P=0.24). Radial route was used in majority (88.6%). The risk factors found to be significantly associated with the development of post-PCI bleeding were diabetes (OR: 6.4; P < 0.0001), hypertension (OR: 13.2; P < 0.0001), smoking (OR:8.31; P<0.0001) and BMI > 40 (OR: 6.8; P < 0.002), use of streptokinase (OR: 3.1; P < 0.0005), femoral approach (OR:4.2; P < 0.02), anaemia (OR: 44.8; P < 0.0001) and ACT ≥ 350 (OR: 3.73; P < 0.0005). In our study, female gender, procedure time ≥60 minutes, use of Glycoproteins IIb/IIIa inhibitors (GPI), and patient's age ≥50 years did not show significant association with post PCI bleeding. Conclusion: Major bleeding complications during Percutaneous Coronary Intervention (PCI) though occur rarely, are an important cause of patient morbidity and mortality.
    No preview · Article · Oct 2011 · Pakistan Journal of Medical Sciences Online
  • [Show abstract] [Hide abstract] ABSTRACT: 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. 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). 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). 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.
    No preview · Article · Mar 2014 · American heart journal
Show more