After PCI, 5-year revascularization, MACE rates higher in women than men
Researchers pooled patient-level data from 21 randomized trials of bare-metal and drug-eluting stents.
Women had a higher risk of major adverse cardiac events (MACE) and or ischemia-driven target lesion revascularization than men in the five years following percutaneous coronary intervention (PCI), according to a large-scale pooled analysis of contemporary PCI trials.
To examine the sex-related risk of five-year cardiovascular outcomes after PCI, researchers pooled patient-level data from 21 randomized trials of bare-metal and drug-eluting stents. They assessed the association between sex and MACE (cardiac death and myocardial infarction) or ischemia-driven target lesion revascularization), as well as individual components at five years. The study was published April 6 by the Journal of the American College of Cardiology.
Median follow-up was 1,095 days (interquartile range, 395 to 1,807 days). Among 32,877 patients, 9,141 (27.8%) were women. Women were less likely to have a history of surgical or percutaneous revascularization. Lesions in women had a smaller reference vessel diameter and shorter lesion length by angiographic core laboratory analysis.
At five years, women had a higher unadjusted rate of MACE (18.9% vs. 17.7%; P=0.003), all-cause death (10.4% vs. 8.7%; P=0.0008), cardiac death (4.9% vs. 4.0%; P=0.003), and revascularization (10.9% vs. 10.2%; P=0.02) versus men. In a multivariable analysis, female sex was an independent predictor of MACE (hazard ratio [HR], 1.14; 95% CI, 1.01 to 1.30; P=0.04) and revascularization (HR, 1.23; 95% CI, 1.05 to 1.44; P=0.009), but not all-cause death (HR, 0.91; 95% CI, 0.75 to 1.09; P=0.30) or cardiac death (HR, 0.97; 95% CI, 0.73 to 1.29; P=0.85).
The researchers noted imbalances in baseline clinical and angiographic characteristics between men and women. They wrote that multivariable models and imputed models for missing data not only confirmed the association between female sex and MACE but “strengthened the conclusion that female sex is a risk factor as the relationship between sex and all-cause death became significant.”
An accompanying editorial noted that women are underevaluated and undertreated for stable ischemic heart disease and acute coronary syndrome, that women derive at least comparable benefit from PCI versus men, and that higher-risk women and men benefit from an early invasive strategy. “Despite a lower atherosclerotic disease burden and reduced target lesion complexity, women remain at high risk of MACE after PCI, which underscores the need for use of appropriate evidence-based therapies in this population,” they wrote.