Gender difference in long-term clinical outcomes after percutaneous coronary intervention

Background The comparative gender-specific outcome after PCI in real-world practice is limited. We investigated the gender difference in the 5-year outcome after percutaneous coronary intervention (PCI). Methods A retrospective study. nationwide PCI registry. All PCI performed in Korea in year 2011 (N=48,783). Outcomes adjusted with age and propensity for clinical characteristics were compared. Primary outcome was 5-year cumulative incidence of major adverse clinical event (MACE) consisting of all-cause death, revascularization, shock, or stroke. Results In unadjusted analysis, women (N=15,710) were older (69.7±9.7 versus 62.0±11.1 year) and had higher frequency of comorbidities including hypertension, hyperlipidemia, and diabetes compared to men (N=33,073) (p<0.001, all). Women had higher 5-year cumulative incidence of MACE than men (41.9% versus 37.2%; hazard ratio [HR] 1.16, 95% confidential interval [CI] 1.12–1.19; p<0.001). In propensity score-matched 14,462 pairs, women had lower 5-year mortality risk (40.7% versus 46.0%, HR 0.85, 95% CI 0.82–0.88, p<0.001). The lower 5-year MACE risk in women was consistent in subgroup analyses of age, risk factors, and clinical diagnosis including angina or acute myocardial infarction (p<0.05, all). The risk of all-cause death, revascularization, and shock were also lower in women than men (p<0.05, all) but the risk of stroke was not different between women and men. Conclusions The apparent worse outcome in women can be explained by older age and more common comorbidities in women. After adjusting these disadvantages, women had better outcome after PCI than men. Our result suggests presence of the reversal paradox in the gender-specific outcome following PCI. Women vs men, 5 year outcome Funding Acknowledgement Type of funding source: None