Sex and Outcomes After Percutaneous Coronary Intervention: A Cause for Concern for Young Women and Those With ST‐Segment Elevation Myocardial Infarction?

Tamis-Holland, Jacqueline

doi:10.1161/jaha.117.005739

Cited by 13 publications

(11 citation statements)

References 35 publications

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“…This is in keeping with the previous and current literature demonstrating inferior outcomes for females when compared to males postcardiac surgery and revascularization [7,8,10,14,41]. Second, in studies that performed risk adjustments or propensity matching, the differences between males and females were reduced or eliminated [14][15][16]18,19,22,24,25,30,32,33]. This suggests that the female sex is not necessarily an independent predictor of mortality postoperatively, but the increased preoperative comorbidities that females present with confer a larger impact on their outcomes.…”

Section: Discussionsupporting

confidence: 91%

“…This has led to difficulty interpreting the results of the literature, as when preoperative comorbidities and intraoperative approach are not controlled confounding variables prevent accurate analysis of the data. The majority of the studies noted in this review, as well and numerous other publications in the literature, have demonstrated that inferior outcomes experienced by females diminish after adjusting for preoperative risk and controlling for surgical approach [14][15][16]18,19,22,24,25,30,32,33]. This process reduces the number of confounding variables and most studies have not determined that female sex is an independent predictor of adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Review of the differences in outcomes between males and females after revascularization

EL‐Andari

Bozso

Kang

et al. 2021

Current Opinion in Cardiology

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Purpose of reviewThis review aims to compare outcomes of males and females undergoing coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), off-pump CABG (OPCAB), minimally invasive direct CABG (MIDCAB), and robotic total endoscopic CABG (TECAB). Recent findingsFemales demonstrated increased rates of morbidity and mortality post PCI and CABG. In studies that performed risk adjustments, these differences were reduced. Although inferior outcomes were observed for females in some measures, generally outcomes between males and females were comparable post OPCAB, MIDCAB, and TECAB SummaryPrevious literature has demonstrated that females undergoing coronary revascularization experience inferior postoperative outcomes when compared to their male counterparts. The discrepancies between males and females narrow, but do not disappear when preoperative risks are accounted for and when considering minimally invasive approaches such as MIDCAB, OPCAB, and TECAB. Minimally invasive cardiac surgery has demonstrated numerous benefits with reduced morbidity, mortality, and shorter recovery times. In patients with increased comorbidities, minimally invasive approaches confer a greater advantage. As females often fall within this category, it is paramount that the diagnosis and referral process be optimized to account for preoperative differences to provide the most beneficial approach if the disparity between the sexes is to be addressed.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Review of the differences in outcomes between males and females after revascularization

EL‐Andari

Bozso

Kang

et al. 2021

Current Opinion in Cardiology

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“…Additionally, a Danish report suggested that women may be more sensitive compared with men to the deleterious effects of smoking [ 6 ]. According to other studies [ 21 , 26 ], women are more susceptible to the effects of nicotine consumption, which causes vasoconstriction, compared with men. Although previous studies [ 20 , 27 ] have reported that less aggressive treatment of acute coronary syndrome may be a causative factor to poorer outcomes in women than in men, in this study, the proportions of primary PCI (92.5% vs. 91.7%, p = 0.508) and PCI within 24 h (78.0% vs. 75.8%, p = 0.354) were similar at baseline ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

Sex difference after acute myocardial infarction patients with a history of current smoking and long-term clinical outcomes: Results of KAMIR Registry

et al. 2022

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Background The contribution of sex as an independent risk factor for cardiovascular disease still remains controversial. The present study investigated the impact of sex on long-term clinical outcomes in Korean acute myocardial infarction (AMI) patients with a history of current smoking on admission after drug-eluting stents (DESs). Methods A total of 12,565 AMI patients (male: n = 11,767 vs. female: n = 798) were enrolled. Major adverse cardiac events (MACEs) comprising all-cause death, recurrent myocardial infarction (Re-MI), and any repeat revascularization were the primary outcomes that were compared between the two groups. Probable or definite stent thrombosis (ST) was the secondary outcome. Results After adjustment, the early (30 days) cumulative incidences of MACEs (adjusted hazard ratio [aHR]: 1.457; 95% confidence interval [CI]: 1.021–2.216; p = 0.035) and all-cause death (aHR: 1.699; 95% CI: 1.074–2.687; p = 0.023) were significantly higher in the female group than in the male group. At 2 years, the cumulative incidences of all-cause death (aHR: 1.561; 95% CI: 1.103–2.210; p = 0.012) and Re-MI (aHR: 1.800; 95% CI: 1.089–2.974; p = 0.022) were significantly higher in the female group than in the male group. However, the cumulative incidences of ST were similar between the two groups (aHR: 1.207; 95% CI: 0.583–2.497; p = 0.613). Conclusions The female group showed worse short-term and long-term clinical outcomes compared with the male group comprised of Korean AMI patients with a history of current smoking after successful DES implantation. However, further studies are required to confirm these results.

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“…For example nicotine, a key component of cigarette smoke induces vasospasm, a mechanism of STEMI known to be more common in females. (22,25) STEMI patients present later and receive less standardised treatment if they are female, resulting in greater mortality. (25) This discrepancy in outcomes is mirrored at all stages of risk prevention for CHD.…”

Section: Discussionmentioning

confidence: 99%

“…(22,25) STEMI patients present later and receive less standardised treatment if they are female, resulting in greater mortality. (25) This discrepancy in outcomes is mirrored at all stages of risk prevention for CHD. In a study of 172 physicians, the "attitude study", found that physicians perceived coronary artery disease in males as being more important than in females.…”

Section: Discussionmentioning

confidence: 99%

Differential Risk of ST-Segment Elevation Myocardial Infarction in Male and Female Smokers

Palmer

Lloyd

Steele

et al. 2019

Journal of the American College of Cardiology

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Sex and Outcomes After Percutaneous Coronary Intervention: A Cause for Concern for Young Women and Those With ST‐Segment Elevation Myocardial Infarction?

Cited by 13 publications

References 35 publications

Review of the differences in outcomes between males and females after revascularization

Review of the differences in outcomes between males and females after revascularization

Sex difference after acute myocardial infarction patients with a history of current smoking and long-term clinical outcomes: Results of KAMIR Registry

Differential Risk of ST-Segment Elevation Myocardial Infarction in Male and Female Smokers

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