Short- and Long-Term Outcomes of Coronary Stenting in Women Versus Men

Abstract

Background— Conflicting evidence exists on sex-based outcomes after coronary stenting. Methods and Results— Data on 426 996 patients ≥65 years old (42.3% women) from the National Cardiovascular Data Registry CathPCI Registry (2004–2008) were linked to Medicare inpatient claims to compare in-hospital outcomes by sex and long-term outcomes by sex and stent type. In-hospital complications were more frequent in women than in men: death (3869 [2.2%] versus 3737 [1.6%]; adjusted odds ratio, 1.41; 95% confidence interval [CI], 1.33–1.49), myocardial infarction (2365 [1.3%] versus 2858 [1.2%]; odds ratio, 1.19; 95% CI, 1.11–1.27), bleeding (7860 [4.4%] versus 5627 [2.3%]; odds ratio, 1.86; 95% CI, 1.79–1.93), and vascular complications (2381 [1.3%] versus 1648 [0.7%]; odds ratio, 1.85; 95% CI, 1.73–1.99). At 20.4 months, women had a lower adjusted risk of death (hazard ratio [HR], 0.92; 95% CI, 0.90–0.94) but similar rates of myocardial infarction, revascularization, and bleeding. Relative to bare metal stent use, drug-eluting stent use was associated with similar improved long-term outcomes in both sexes: death (women: adjusted HR, 0.78; 95% CI, 0.76–0.81; men: HR, 0.77; 95% CI, 0.74–0.79), myocardial infarction (women: HR, 0.79; 95% CI, 0.74–0.84; men: HR, 0.81; 95% CI, 0.77–0.85), and revascularization (women: HR, 0.93; 95% CI, 0.90–0.97; men: HR, 0.91; 95% CI, 0.88–0.94). There was no interaction between sex and stent type for long-term outcomes. Conclusions— In contemporary coronary stenting, women have a slightly higher procedural risk than men but have better long-term survival. In both sexes, use of a drug-eluting stent is associated with lower long-term likelihood for death, myocardial infarction, and revascularization.