Medical Chronicle November/December 2013

CARDIAC PCI: Outcomes in women In the US, women make up nearly 43% of all patients presenting with an acute coronary syndrome. Early studies have shown that women who undergo a percutaneous coronary intervention (PCI) have a higher incidence of adverse outcomes during and after PCI. It has also been shown that women undergoing PCI have more comorbid conditions such as hypertension, for example, and they have more complex and diffuse coronary disease. In addition, they experience longer referral times. be able to use multivariate risk adjustment evaluation. 4. There are currently no studies to evaluate if the two genders should be treated differently, for instance, evaluating if bleeding risk for women is larger using certain anticoagulation. Aim of t he study This was a large registry type of study that had the aim of evaluating the predictors of one-year mortality and major adverse cardiovascular events (MACEs). Method The authors used a large PCI registry and in a retrospectively manner evaluated 6929 patients presenting with an acute coronary syndrome. All patients were followed for at least one year for the development of death or MACEs, which were defined as allcause mortality, myocardial infarction and target lesion revascularisation. Results Women were significantly older than men and had significantly more diabetes, hypertension, chronic renal insufficiency and peripheral arterial disease than men. At one year, women had higher mortality than men (10.7% vs 7.5%), p <0.001 and major adverse cardiovascular events (16.4% vs 12.7%), p <0.001. The predictors of death common in both genders were chronic renal insufficiency, diabetes mellitus, age, body mass index and baseline haematocrit. In women only, more complex coronary lesions and cholesterol levels were predictors of death. In men only, peripheral arterial disease and current smoking were predictors of death. Conclusions 1. There are differences in clinical outcome between women and men after PCI for acute coronary syndromes. 2. There are also differences in the predictors of a worse outcome between the genders. 3. Larger studies are needed to MEDICAL CHRONICLE NOVEMBER/DECEMBER 2013 27

Medical Chronicle November/December 2013 | Page 27