Gender Difference In In-Hospital Mortality Following Coronary Angioplasty: Is It True Only In An Emergency Context ?

The aim of this study is to assess whether the excess risk of in-hospital mortality in women is noticed only when percutaneous coronary intervention (PCI) is performed in emergency after St+ acute coronary syndrome (ACS) or whether the excess risk is also observed after non-St+ ACS or unstable angina. During 3 years (2005–2007), 7847 consecutive PCI were performed in the University Department of Cardiology. The number of PCI performed in emergency for St+ ACS was 1529. The main end-point was in-hospital death and secondary outcomes included during the first 48 hours: stroke, emergency CABG surgery, recurrent myocardial infarction, new PCI and renal or vascular adverse events. The association between gender and in-hospital outcomes was assessed using multivariate logistic regression analysis. The proportion of women was 22.2% (n=340:1529) when angioplasty (in emergency) was performed in St+ ACS. History of renal failure was more prevalent in women (17.6% vs. 9.7%, p=0.001) whereas history of ischemic heart disease (previous myocardial infarction, coronary angioplasty or CABG surgery) was not significantly higher in men (24.1% vs. 20.9%). The percentage of deaths was 5.3% in women and 1.7% in men (p=0.001). The risk (OR [95% CI]) of in-hospital mortality for women vs. men (crude analysis) was 3.26 ([1.70 – 6.23], p=0.001) and 2.31 ([1.14 – 4.69], p=0.02) after multivariate adjustment for age, ischemic heart disease, year of procedure, renal failure, number of vessel disease, number of treated coronary arteries and thrombolytic therapy. The proportions of deaths were identical (0.64% and 0.60% in women and men respectively) when PCI was performed in a non-emergency setting in non-St+ ACS or unstable angina. The risk was similar before and after multivariate adjustment; 1.06 ([0.50 –2.26], p=0.87) and 0.91 ([0.42–1.98], p=0.81) respectively. The higher risk of in-hospital mortality for women is noticed only when PCI is performed in an emergency setting after St+ ACS. In non-urgent procedures the risk of death is similar to the one observed in men.