Study Overview

Objective. To determine whether female sex is an indepen-dent risk factor for percutaneous coronary intervention (PCI) mortality and/or complications in contemporary practice. Design. Observational, cohort study. Setting and participants. The data used were from the National Cardiovascular Network (NCN) database of 109,708 PCI cases from 22 hospitals between January 1994 and January 1998 [1]. The NCN database contains voluntary, confidential, and blinded data from hospitals and physicians with the purpose of internal benchmarking and quality improvement. Female participants (33%) had a mean age 66.3 years and a mean body surface area of 1.77 m2; 91.8 % of women were white. Male participants (67%) had a mean age of 61.5 years and a mean body surface area of 2.04 m2; 93.8% of men were white. Women had more comorbid illnesses than did men, but also less extensive coronary disease. Main outcome measures. Inhospital mortality was defined as death during or after the index procedure but before hospital discharge. Other outcome measures were stroke (persistent neurologic deficit or coma) and vascular complications (peri-pheral vessel occlusion, large hematoma prolonging hospital stay, pseudo-aneurysm, bleeding requiring transfusion, requirement for surgical repair, aortic dissection, iliac or femoral dissection, and acute limb ischemia). Association of sex with unadjusted and risk-adjusted procedural outcomes was evaluated using a regression model. Main results. Women had higher unadjusted inhospital mor-tality rates (1.8 % versus 1.0%; P < 0.001), more strokes (0.4% versus 0.2%; P < 0.001), and higher vascular complication rates (5.4 % versus 2.7%; P < 0.001). However, after adjusting for baseline clinical risk factors and body surface area, women and men had similar PCI mortality risk (adjusted odds ratio, 1.07 [95 % confidence interval, 0.92 to 1.24]). Sex was not an inde-pendent risk factor for mortality among subgroups receiving coronary stent or atherectomy devices after risk adjustment. However, women undergoing PCI remained at higher risk for stroke, vascular complications, and repeat inhospital revascu-larization than men, even after risk adjustment. Conclusion. In contemporary practice, a patient’s body size, rather than sex, conveys independent risk for mortality afte