Temporal Trends in Percutaneous Coronary Interventions - Is There a Difference Between Genders?

Background - Cardiovascular disease continues to be the leading cause of death among women, in whom the mortality rate remains higher compared to men. Studies have suggested gender-related differences in diagnostic and invasive therapeutic coronary procedures. We aimed to assess gender differences over time regarding management and outcomes of percutaneous coronary interventions (PCI).

Methods - Consecutive PCI`s performed between 2004 and 2017, were distinguished by procedural date [Q1:1/2004-6/2008, Q2: 7/2008-12/2012, Q3:1/2013-5/2017] and gender. We examined gender related differences over time regarding patient’s and procedural characteristics. The primary outcome was death, myocardial infarction (MI), total vessels revascularization (TVR) and coronary artery bypass surgery (CABG).

Results - Of 21,763 patients undergoing PCI, 22.5% were female (F). Prior malignancy and renal failure increased significantly in both sexes over the years. Compared with the early periods (Q1 or Q2), there was an increase in Q3 in the rate of difficult PCIs (F 18.9%, 22.1%; M 16.2%, 20.6%; p<0.05), unprotected left-main angioplasty (F 2.3%, 6.9%; M 1.1%, 3.4%; p<0.05) and interventions to calcified lesions (F 11.4%, 18.2%; M 7.7%, 11.7%; p<0.05). These complex interventions were more common in females (p<0.01 each). Nevertheless, the radial approach was increasingly utilized in both sexes (F[Q1 vs. Q3]:1.9%-63.1%; M[Q1 vs. Q3]:1.9%-72.1%; p<0.05). Upon adjustment, the composite outcome of death, MI, TVR and CABG did not differ between sexes. However, the overall mortality was slightly higher in female [Hazard ration 1.14 (95% CI 1.07-1.21)].

Conclusion - PCI has evolved over the years to offer better outcome to more elderly patients with more comorbidities. During the last 2 decades, more advanced and complex interventions have been performed both in female and male, with a higher rate in female. However, during the years, there was no difference by gender in clinical outcomes, except for a slightly higher rate of mortality among female.