Percutaneous Coronary Angioplasty in Argentina. Sex Differences in Early and Long-Term Results. Conarec V Registry

pp 539-549

Abstract

Background

Percutaneous transluminal coronary angioplasty is a safe and effective method of myocardial revascularization in selected patients. However, the effects of gender on angioplasty outcome, have not been characterized yet.

Objective

To compare in-hospital and long-term outcome after percutaneous transluminal coronary angioplasty in women and men in our country.

Material and method

The registry prospectively included 1295 consecutive patients who underwent percutaneous transluminal coronary angioplasty, at 41 medical centers with cardiology residency programs, during six months of 1996. Angiographic success was defined as a residual stenosis < 30% and clinical success as angiographic success free of inhospital major events (death, acute myocardial infarction or urgent coronary artery bypass graft surgery). Clinical events during follow-up included: death, myocardial infarction, and need of a new percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery. Follow-up was completed in 1152 patients (91.9%) of 1254 without in-hospital deaths at mean time of 14 ± 8 months.

Results

The results showed that women were older than men (65.5 ± 10 vs. 59.2 ± 11 years old, p < 0.0001), had a higher prevalence of hypertension (71.2% vs.58.9%, p < 0.001), prior to angina (47.0% vs. 39.1%, p= 0.02), unstable angina (66.9% vs. 58.8%, p = 0.02)and one-vessel disease (62.2% vs. 53.8%, p < 0.02). Men had more history of tobacco (42.2% vs. 24.2%, p <0.001), previous myocardial infarction (32.3% vs. 21.4%, p= 0.001), chronic stable angina (19.6% vs. 13.2%, p = 0.02), multiple vessel disease (16.1% vs. 10.3%, p < 0.02) and stent implantation (49.5% vs. 42.3%, p < 0.04). Women had similar angiographic success rate (89% vs.90.9%, respectively, p = 0.38), higher in-hospital mortality (6.0% vs. 2.4%, p = 0.003) and less clinical success rate (82.9% vs. 87.5%, p < 0.05). During the follow-up period, there were no significant gender differences in the cumulative requirement for coronary artery bypass surgery (7.1% vs. 8.5%), myocardial infarction (6.4% vs. 5.6%), event free survival (71.2% versus 69.5%) and combined end points (23;1% vs. 26.2%). In women there was a trend to-ward more cumulative mortality (8.9% vs. 5.8%, p =0.06) and men had significantly more coronary angioplasty (12.7% vs. 7.1%, p=0.01).

Conclusions

Women undergoing coronary angioplasty have higher procedural mortality risk than men; this is explained -in part- by their worse cardiovascular risk factor profile. The angiographic success rate and long-term prognosis were similar for both genders, except that women did not have significantly more mortality and men did not have more requirement of repeated angioplasty.