Gender is Not a Predictor of Mortality or Major Adverse Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes

Background: Historically, studies of percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) have reported worse outcomes for women. We sought to determine if contemporary PCI techniques eliminate gender differences in PCI outcomes. Methods: This was a retrospective study of 4,776 consecutive patients who underwent PCI for acute coronary syndromes between January 2008 and July 2015. Primary outcomes studied were major adverse cardiovascular events (MACE) and death at 1 year. Results: Percutaneous coronary intervention success was similar in men and women (97.8% v 97.7%, p = 0.76). There was no significant gender difference in the number of vessels attempted (1.14 vs 1.12, p = 0.25), mean number of lesions treated (1.34 vs 1.32, p = 0.21) or the mean number of stents used (1.32 vs 1.30, p = 0.31). There was equivalent use of drug eluting stents (38.2% vs 38.3%, p = 0.94). Women with ST-elevation myocardial infarction STEMI had longer median symptom-to-door time (111 vs 90 mins, p = 0.0411) but there was no gender difference in door-to-balloon time or symptom-to-balloon time. There was no significant difference in percentages of women and men <75 years treated with prasugrel or ticagrelor (11.1% vs 13.4%, p = 0.092). Unadjusted 1-year mortality was 6.4% for women and 4% for men (p = 0.0012), but on multivariate analysis, female sex was not a predictor of death. There was no significant gender difference in the overall incidence of unadjusted 1-year MACE (11.6% vs 10.8%, p = 0.434). Conclusions: When contemporary PCI techniques are applied equally to men and women with ACS there is no gender difference in mortality or MACE at 1 year.