PCI with a DES: Comparing 10-year outcomes between men and women
Mortality rates 10 years after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) are comparable between men and women, according to a new analysis published in Circulation.[1] However, the study’s authors did uncover some key differences between the two sexes.
“In recent years, there has been significant scientific interest in comparing sex-related clinical outcomes after PCI,” wrote first author J.J. Coughlan, MB BCh, an interventional cardiologist with the Technical University of Munich in Germany, and colleagues. “However, some of the evidence in this field has been conflicting.”
Hoping to learn more, the group examined 10-year follow-up data from nearly 10,000 patients who underwent PCI with a DES. All data came from a pooled analysis of five different randomized trials. Seventy-six percent of patients were men. The mean ages were 64.3 years old among men and 69.6 years old among women. Women were more likely to present with diabetes or hypertension, and men were more likely to be current smokers or present with a history of prior myocardial infarction (MI).
Overall, after 10 years, cardiovascular mortality had occurred in 18.5% of women and 14.3% of men. Overall mortality, on the other hand, was seen in 34.7% of women and 28.3% of men.
After making certain adjustments, however, Coughlan et al. determined that the mortality risk was comparable between these two groups.
One key difference revealed by the pooled analysis was that women faced a higher risk of MI within 30 days of PCI with a DES. After 30 days, though, the MI risk was similar between men and women.
“This finding is in line with a previous study (with follow-up limited to 5 years) that reported worse outcomes in female patients compared with male patients in the early phase after PCI with DES,” the authors wrote. “The reason for the increased risk of MI observed in female patients in the early postprocedural period remains unclear and persisted after statistical adjustment for multiple variables. These differences may reflect the presence of unmeasured confounders or underlying physiological differences in the response of female and male coronary vessels to stent implantation. However, given the observational nature of this study, the exact causation of this finding cannot be determined.”
Another important difference between men and women who underwent DES PCI was that repeat revascularization of the target lesion, target vessel or nontarget vessels was more likely among men than women. There is a chance that this difference is a sign of treatment bias, the authors wrote. Further research is still needed so that clinicians can learn more.
Coughlan et al. concluded by emphasizing the importance of tracking long-term outcomes after PCI with a DES. In addition to providing clinicians with a “more informative” view of these procedures and their impact on patient care, the group wrote, “these data serve as a reminder that patients undergoing DES implantation need aggressive secondary prevention measures to optimize their cardiac risk and minimize their chances of experiencing recurrent events in the longer term, regardless of their sex.”
Read the full analysis here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.