Differences in prognostic factors and outcomes between women and men undergoing coronary artery stenting

Context Women with coronary artery disease (CAD) are believed to have a hig her risk for adverse outcomes than men after conventional coronary interven tions. The increasing use of coronary stenting has improved the outcome of patients undergoing coronary interventions, but little is known about the n ature of outcomes in men vs women after this procedure. Objective To examine whether there are sex-based differences in prognostic factors and in early and late outcomes among CAD patients undergoing corona ry stent placement. Design, Setting, and Patients Inception cohort study, at 2 tertiary referra l institu tions in Germany. Consecutive series of 1001 women and 3263 men w ith symptomatic CAD who were treated with stenting between May 1992 and Dec ember 1998. Patients who underwent stenting in the setting of acute myocard ial infarction were excluded. Main Outcome Measure The combined event rates of death and nonfatal myocard ial infarction, assessed at 30 days and 1 year after stenting and compared by sex, Results Compared with men, women undergoing coronary stenting were signific antly older (mean age, 69 vs 63 years) and more likely to present with diab etes, arterial hypertension, or hypercholesterolemia. Women had less extens ive CAD, a less frequent history of myocardial infarction and better preser ved left ventricular function than men. Women presented an excess risk of d eath or nonfatal myocardial infarction only during the early period after s tenting: the 30-day combined event rate of death or myocardial infarction w as 3.1% in women and 1.8% in men (P = .02) and the multivariate-adjusted ha zard ratio (HR) for women was 2.02 (95% confidence interval [CI], 1.27-3.19 ). At 1 year, the outcome was similar for both women and men (combined even t rate for women, 6.0%, and for men, 5.8% (P = .77); multivariate-adjusted HR for women, 1.06 [95% CI, 0.75-1.48]). There was a sex difference in the prognostic value of baseline characteristics: the strongest prognostic fact ors were diabetes in women and age in men. Conclusions The results of this study indicate that 1-year outcomes of wome n with CAD undergoing coronary artery stenting are similar to those of men. Despite the similarity in outcomes, there are several sex-specific differe nces in baseline characteristics, clinical course after the intervention, a nd relative weight of prognostic factors.