Sex differences in long-term cause-specific mortality after percutaneous coronary intervention temporal trends and mechanisms

Claire E. Raphael, Mandeep Singh, Malcolm Bell, Daniel Crusan, Ryan J. Lennon, Amir Lerman, Abhiram Prasad, Charanjit Rihal, Bernard J. Gersh, Rajiv Gulati

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background—Women have higher rates of all-cause mortality after percutaneous coronary intervention. Whether this is because of greater age and comorbidity burden or a sex-specific factor remains unclear. Methods and Results—We retrospectively assessed cause-specific long-term mortality after index percutaneous coronary intervention over 3 time periods (1991–1997, 1998–2005, and 2006–2012). Cause of death was determined using telephone interviews, medical records, and death certificates. We performed competing risks analyses of cause-specific mortality. A total of 6847 women and 16 280 men survived index percutaneous coronary intervention hospitalization 1991 to 2012. Women were older (mean±SD: 69.4±12 versus 64.8±11.7 years; P<0.001) with more comorbidities (mean±SD: Charlson index 2.1±2.1 versus 1.9±2.1; P<0.001). Across the 3 time periods, both sexes exhibited a decline in cardiac deaths at 5 years (26% relative decrease in women, 17% in men, trend P<0.001 for each). Although women had higher all-cause mortality compared with men in all eras, the excess mortality was because of noncardiac deaths. In the contemporary era, only a minority of deaths were cardiac (33.8% in women, 38.0% in men). After adjustment, there was no evidence for a sex-specific excess of risk for cardiac or noncardiac mortality. The commonest causes of death were chronic diseases and heart failure in women (5-year cumulative mortality, 5.4% and 3.9%) but cancer and myocardial infarction/sudden death in men (5.4% and 4.3%). Conclusions—The higher mortality after percutaneous coronary intervention in women is because of death from noncardiac causes. This is accounted for by baseline age and comorbidities rather than an additional sex-specific factor. These findings have implications for sex-specific clinical care and trial design. (Circ Cardiovasc Interv. 2018;11:e006062.

Original languageEnglish (US)
Article numbere006062
JournalCirculation: Cardiovascular Interventions
Volume11
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Percutaneous Coronary Intervention
Sex Characteristics
Mortality
Sex Factors
Comorbidity
Cause of Death
Death Certificates
Sudden Death
Medical Records
Hospitalization
Chronic Disease
Heart Failure
Myocardial Infarction
Clinical Trials
Interviews

Keywords

  • Mortality
  • Myocardial infarction
  • Percutaneous coronary intervention
  • Sex
  • Women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sex differences in long-term cause-specific mortality after percutaneous coronary intervention temporal trends and mechanisms. / Raphael, Claire E.; Singh, Mandeep; Bell, Malcolm; Crusan, Daniel; Lennon, Ryan J.; Lerman, Amir; Prasad, Abhiram; Rihal, Charanjit; Gersh, Bernard J.; Gulati, Rajiv.

In: Circulation: Cardiovascular Interventions, Vol. 11, No. 3, e006062, 01.03.2018.

Research output: Contribution to journalArticle

Raphael, Claire E. ; Singh, Mandeep ; Bell, Malcolm ; Crusan, Daniel ; Lennon, Ryan J. ; Lerman, Amir ; Prasad, Abhiram ; Rihal, Charanjit ; Gersh, Bernard J. ; Gulati, Rajiv. / Sex differences in long-term cause-specific mortality after percutaneous coronary intervention temporal trends and mechanisms. In: Circulation: Cardiovascular Interventions. 2018 ; Vol. 11, No. 3.
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abstract = "Background—Women have higher rates of all-cause mortality after percutaneous coronary intervention. Whether this is because of greater age and comorbidity burden or a sex-specific factor remains unclear. Methods and Results—We retrospectively assessed cause-specific long-term mortality after index percutaneous coronary intervention over 3 time periods (1991–1997, 1998–2005, and 2006–2012). Cause of death was determined using telephone interviews, medical records, and death certificates. We performed competing risks analyses of cause-specific mortality. A total of 6847 women and 16 280 men survived index percutaneous coronary intervention hospitalization 1991 to 2012. Women were older (mean±SD: 69.4±12 versus 64.8±11.7 years; P<0.001) with more comorbidities (mean±SD: Charlson index 2.1±2.1 versus 1.9±2.1; P<0.001). Across the 3 time periods, both sexes exhibited a decline in cardiac deaths at 5 years (26{\%} relative decrease in women, 17{\%} in men, trend P<0.001 for each). Although women had higher all-cause mortality compared with men in all eras, the excess mortality was because of noncardiac deaths. In the contemporary era, only a minority of deaths were cardiac (33.8{\%} in women, 38.0{\%} in men). After adjustment, there was no evidence for a sex-specific excess of risk for cardiac or noncardiac mortality. The commonest causes of death were chronic diseases and heart failure in women (5-year cumulative mortality, 5.4{\%} and 3.9{\%}) but cancer and myocardial infarction/sudden death in men (5.4{\%} and 4.3{\%}). Conclusions—The higher mortality after percutaneous coronary intervention in women is because of death from noncardiac causes. This is accounted for by baseline age and comorbidities rather than an additional sex-specific factor. These findings have implications for sex-specific clinical care and trial design. (Circ Cardiovasc Interv. 2018;11:e006062.",
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T1 - Sex differences in long-term cause-specific mortality after percutaneous coronary intervention temporal trends and mechanisms

AU - Raphael, Claire E.

AU - Singh, Mandeep

AU - Bell, Malcolm

AU - Crusan, Daniel

AU - Lennon, Ryan J.

AU - Lerman, Amir

AU - Prasad, Abhiram

AU - Rihal, Charanjit

AU - Gersh, Bernard J.

AU - Gulati, Rajiv

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Y1 - 2018/3/1

N2 - Background—Women have higher rates of all-cause mortality after percutaneous coronary intervention. Whether this is because of greater age and comorbidity burden or a sex-specific factor remains unclear. Methods and Results—We retrospectively assessed cause-specific long-term mortality after index percutaneous coronary intervention over 3 time periods (1991–1997, 1998–2005, and 2006–2012). Cause of death was determined using telephone interviews, medical records, and death certificates. We performed competing risks analyses of cause-specific mortality. A total of 6847 women and 16 280 men survived index percutaneous coronary intervention hospitalization 1991 to 2012. Women were older (mean±SD: 69.4±12 versus 64.8±11.7 years; P<0.001) with more comorbidities (mean±SD: Charlson index 2.1±2.1 versus 1.9±2.1; P<0.001). Across the 3 time periods, both sexes exhibited a decline in cardiac deaths at 5 years (26% relative decrease in women, 17% in men, trend P<0.001 for each). Although women had higher all-cause mortality compared with men in all eras, the excess mortality was because of noncardiac deaths. In the contemporary era, only a minority of deaths were cardiac (33.8% in women, 38.0% in men). After adjustment, there was no evidence for a sex-specific excess of risk for cardiac or noncardiac mortality. The commonest causes of death were chronic diseases and heart failure in women (5-year cumulative mortality, 5.4% and 3.9%) but cancer and myocardial infarction/sudden death in men (5.4% and 4.3%). Conclusions—The higher mortality after percutaneous coronary intervention in women is because of death from noncardiac causes. This is accounted for by baseline age and comorbidities rather than an additional sex-specific factor. These findings have implications for sex-specific clinical care and trial design. (Circ Cardiovasc Interv. 2018;11:e006062.

AB - Background—Women have higher rates of all-cause mortality after percutaneous coronary intervention. Whether this is because of greater age and comorbidity burden or a sex-specific factor remains unclear. Methods and Results—We retrospectively assessed cause-specific long-term mortality after index percutaneous coronary intervention over 3 time periods (1991–1997, 1998–2005, and 2006–2012). Cause of death was determined using telephone interviews, medical records, and death certificates. We performed competing risks analyses of cause-specific mortality. A total of 6847 women and 16 280 men survived index percutaneous coronary intervention hospitalization 1991 to 2012. Women were older (mean±SD: 69.4±12 versus 64.8±11.7 years; P<0.001) with more comorbidities (mean±SD: Charlson index 2.1±2.1 versus 1.9±2.1; P<0.001). Across the 3 time periods, both sexes exhibited a decline in cardiac deaths at 5 years (26% relative decrease in women, 17% in men, trend P<0.001 for each). Although women had higher all-cause mortality compared with men in all eras, the excess mortality was because of noncardiac deaths. In the contemporary era, only a minority of deaths were cardiac (33.8% in women, 38.0% in men). After adjustment, there was no evidence for a sex-specific excess of risk for cardiac or noncardiac mortality. The commonest causes of death were chronic diseases and heart failure in women (5-year cumulative mortality, 5.4% and 3.9%) but cancer and myocardial infarction/sudden death in men (5.4% and 4.3%). Conclusions—The higher mortality after percutaneous coronary intervention in women is because of death from noncardiac causes. This is accounted for by baseline age and comorbidities rather than an additional sex-specific factor. These findings have implications for sex-specific clinical care and trial design. (Circ Cardiovasc Interv. 2018;11:e006062.

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KW - Myocardial infarction

KW - Percutaneous coronary intervention

KW - Sex

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