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Clinical research

"Gender paradox" in outcome after percutaneous coronary intervention with paclitaxel eluting stents

1. Department of Invasive Cardiology, Istituto Clinico Humanitas Mirasole Spa, Rozzano, Italy; 2. Department of Invasive Cardiology; Casa di Cura Cellini, Torino, Italy

Aims: To evaluate in-hospital and long-term outcome of women undergoing percutaneous coronary intervention (PCI) with paclitaxel-eluting stents (PES) as compared to men and historic controls treated with bare metal stents.

Methods and results: Eight-hundred and ten (810) consecutive patients (642 men and 168 women) with PES were analysed and also compared with 3,515 patients (2,811 men and 704 women) with at least one bare metal stent in the three years previous. In the PES group, women were significantly older than men (mean age of 68±10 vs. 63±10 years, p<0.001), with more diabetes (39.9 vs. 29.7%, p<0.05), smaller treated vessels (<2.5 mm in 34.9 vs. 24.8%, p=0.003), more left-anterior descending lesions (56.6 vs. 43.2%, p<0.001). More men had multivessel disease (78.8 vs. 62.5%, p<0,001), dyslipidaemia (73.2 versus 65.4%, p<0.05), smoking habit (74.3 versus 34.5%, p<0.001) or prior revascularisation (49.7 versus 36.1%, p<0.05). Compared to bare metal stents, similar higher risk features were recorded in women over time. No gender specific differences in in-hospital outcome were observed. At 12 months the rates of cardiac death, acute myocardial infarction (AMI) and late thrombosis were respectively 2.0%, 3.7% and 0% in women and 2.1%, 3.2%, and 1.2% in men (all p=NS).

Conclusions: Albeit with worse baseline clinical and angiographic characteristics in women, very high immediate success rates and a positive outcome can be achieved in both sexes after PES.

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