Sex differences in mortality after percutaneous coronary intervention: a contemporary nationwide registry and prospective cohort analysis.

BACKGROUND

Despite advancements in medical care, coronary artery disease (CAD) remains a leading cause of death. Previous studies have indicated a higher mortality rate for women compared to men following percutaneous coronary intervention (PCI). While both sexes share common risk factors, the magnitude of their impact may differ, and specific sex-related factors contribute to observed disparities. Although attempts have been made to reduce this gap, data concerning medical care and risk factors related to mortality remain limited. This study aims to assess the in-hospital mortality rate following PCI and to investigate sex-specific differences in associated risk factors.

METHODS

We utilized a comprehensive national PCI registry comprising 19,701 patients. The patient cohort was stratified by sex. In-hospital mortality rates were reported, and risk factors related to mortality were analyzed using multivariable models.

RESULTS

Women exhibited a higher in-hospital mortality rate (3.5%) compared to men (2.3%). They were also more significantly affected by specific risk factors that increased mortality exclusively in women: chronic kidney disease (CKD) [odds ratio (OR) 2.73, 95% confidence interval (CI): 1.90-3.93, P<0.001], cerebrovascular disease (OR 2.43, 95% CI: 1.43-4.12, P=0.001), and cardiogenic shock (CS) at the time of PCI (OR 5.6, 95% CI: 3.85-8.15, P<0.001). Furthermore, several factors demonstrated a greater association with mortality in women compared to men. Women undergoing emergency PCI exhibited a higher odds ratio (OR 14.01, 95% CI: 8.03-24.43, P<0.001) than men (OR 3.77, 95% CI: 2.19-6.50, P<0.001). Similar trends were observed for urgent PCI (OR 5.58, 95% CI: 3.08-10.09, P<0.001 vs. OR 2.74, 95% CI: 1.64-4.58, P<0.001) and new required dialysis (OR 7.10, 95% CI: 2.84-17.77, P<0.001 vs. OR 3.28, 95% CI: 1.83-5.86, P<0.001).

CONCLUSIONS

Women undergoing PCI had significantly higher in-hospital and one-year mortality rates than men. Key risk factors for increased mortality in women include a history of stroke, CS, and CKD. While emergency PCI, dialysis initiation, arrhythmias, and procedure failure affect both sexes, their impact was more pronounced in women. Improving prognosis requires increased attention to women's specific needs and enhanced awareness of appropriate peri-procedure care.