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April 28, 1993, Vol 269, No. 16 >
ARTICLE | April 28, 1993

The Changing In-Hospital Mortality of Women Undergoing Percutaneous Transluminal Coronary Angioplasty FREE

Malcolm R. Bell, MB, BS, FRACP; David R. Holmes, Jr, MD; Peter B. Berger, MD; Kirk N. Garratt, MD; Kent R. Bailey, PhD; Bernard J. Gersh, MB, ChB, DPhil
[+] Author Affiliations

Presented in part at the 41st annual meeting of the American College of Cardiology, Dallas, Tex, April 14, 1992.

Reprint requests to Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (Dr Bell).


JAMA. 1993;269(16):2091-2095. doi:10.1001/jama.1993.03500160061032
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Article
References

Objective.  —To compare in-hospital mortality among women and men undergoing percutaneous transluminal coronary angioplasty (PTCA) and determine whether mortality differences have changed recently.

Design.  —A retrospective cohort study.

Setting.  —Tertiary referral institution.

Patients.  —Consecutive series of 3557 patients (27% women) who underwent 4071 PTCA procedures. Two cohorts were analyzed: patients treated between 1979 and 1987 (n=1970) and those treated between 1988 and 1990 (n=2101).

Main Outcome Measures.  —In-hospital and periprocedural mortality.

Results.  —Women were older than men (P<.001) and more had class III or IV angina(P<.001), unstable angina(P<.001), angina at rest (P<.001), cardiac failure (P<.001), and diabetes mellitus, hypertension, and hypercholesterolemia (P<.001). The PTCA was successful in 85% of women and 86% of men with an in-hospital mortality rate of 4.2% and 2.7%, respectively (P=.005). No significant change in mortality occurred in men between the early (2.2%) and late (3.1%) eras in contrast to a significant increase among women, 2.9% to 5.4% (P=.04). Periprocedural mortalities for women and men between 1979 and 1987 were 1.0% and 1.2% (P=not significant) and between 1988 and 1990 were 2.9% and 1.4% (P=.02), respectively. The multivariate odds ratio of in-hospital mortality for women vs men was 1.51 (95% confidence interval, 1.00 to 2.29; P=.05), although six other baseline variables were more powerful predictors of in-hospital mortality. Accounting for body surface area resulted in no significant association between gender and in-hospital mortality. Periprocedural mortality was not independently associated with gender.

Conclusions.  —In-hospital mortality among women has increased in recent years, but their higher mortality compared with men is related more to the severity of their underlying disease rather than gender alone.(JAMA. 1993;269:2091-2095)

REFERENCES

1 +
Cowley MJ, Vetrovec GW, DiSciascio G, Louis SA, Hirsh PD, Wolfgang TC.  Coronary angioplasty of multiple vessels: short-term outcome and long-term results. Circulation . 1985;;72:1314-1320.
2 +
Deligonul U, Vandormael MG, Kern MJ, Zelman R, Galan K, Chaitman BR.  Coronary angioplasty: a therapeutic option for symptomatic patients with two- and three-vessel coronary disease. J Am Coll Cardiol . 1988;;11:1173-1179.
3 +
Bell MR, Bailey KR, Reeder GS, LaPeyre AC III, Holmes DR Jr.  Percutaneous transluminal angioplasty in patients with multi-vessel coronary disease: how important is complete revascularization for cardiac event-free survival? J Am Coll Cardiol . 1991;;16:553-562.
4 +
Parisi AF, Folland ED, Hartigan P, the Veterans Affairs ACME Investigators.  A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. N Engl J Med . 1992;;326:10-16.
5 +
Detre K, Holubkov R, Kelsey S, et al.  Percutaneous transluminal coronary angioplasty in 1985-1986 and 1977-1981: the National Heart, Lung, and Blood Institute Registry. N Engl J Med . 1988;;318: 265-270.
6 +
Gruentzig AR, King SB III, Schlumpf M, Siegenthaler W.  Long-term follow-up after percutaneous transluminal coronary angioplasty: the early Zurich experience. N Engl J Med . 1987;;316:1127-1132.
7 +
Cowley MJ, Mullin SM, Kelsey S, et al.  Sex differences in early and long-term results of coronary angioplasty in the NHLBI PTCA Registry. Circulation . 1985;;71:90-97.
8 +
Ellis SG, Roubin GS, King SB III, et al.  In-hospital cardiac mortality after acute closure after coronary angioplasty: analysis of risk factors from 8207 procedures. J Am Coll Cardiol . 1988;;11:211-216.
9 +
Holmes DR Jr, Holubkov R, Vlietstra RE, et al.  Comparison of complications during percutaneous transluminal coronary angioplasty from 1977 to 1981 and from 1985 to 1986: the National Heart, Lung, and Blood Institute Registry. J Am Coll Cardiol . 1988;;12:1149-1155.
10 +
McEniery PT, Hollman J, Knezinek V, et al.  Comparative safety and efficacy of percutaneous transluminal coronary angioplasty in men and in women. Cathet Cardiovasc Diagn . 1987;;13:364-371.
11 +
Tobin JN, Wassertheil-Smoller S, Wexler JP, et al.  Sex bias in considering coronary bypass surgery. Ann Intern Med . 1987;;107:19-25.
12 +
Ayanian JZ, Epstein AM.  Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med . 1991;;325:221-225.
13 +
Steingart RM, Packer M, Hamm P, et al.  Sex differences in the management of coronary artery disease. N Engl J Med . 1991;;325:226-230.
14 +
Khan SS, Nessim S, Gray R, Czer LS, Chaux A, Matloff J.  Increased mortality of women in coronary artery bypass surgery: evidence for referral bias. Ann Intern Med . 1990;;112:561-567.
15 +
Fisher LD, Ward Kennedy J, Davis KB, et al.  Association of sex, physical size, and operative mortality after coronary artery bypass in the Coronary Artery Surgery Study (CASS). J Thorac Cardiovasc Surg . 1982;;84:334-341.
16 +
Loop FD, Golding LR, MacMillan JP, Cosgrove DM, Lytle BW, Sheldon WC.  Coronary artery surgery in women compared with men: analyses of risks and long-term results. J Am Coll Cardiol . 1983;;1:383-390.
17 +
Campeau L.  Grading of angina pectoris. Circulation . 1976;;54:522-523.
18 +
Vlietstra RE, Holmes DR Jr, Smith HC, Hartzler GO, Orszulak TA.  Percutaneous transluminal coronary angioplasty: initial Mayo Clinic experience. Mayo Clin Proc . 1981;;56:287-293.
19 +
Vlietstra RE, Bresnahan JF, Holmes DR Jr.  Coronary balloon angioplasty.  In: Holmes DR Jr, Vlietstra RE, eds. Interventional Cardiology . Philadelphia, Pa: FA Davis Co Publishers; 1989;:64-66.
20 +
Simpson JB, Baim DS, Robert EW, Harrison DC.  A new catheter system for coronary angioplasty. Am J Cardiol . 1982;;49:1216-1222.
21 +
Turi ZG, Campbell CA, Gottimukkala MV, Kloner RA.  Preservation of distal coronary perfusion during prolonged balloon inflation with an autoperfusion angioplasty catheter. Circulation . 1987;; 75:1273-1280.
22 +
Quigley PJ, Hinohara T, Phillips HR, et al.  Myocardial protection during coronary angioplasty with an autoperfusion balloon catheter in humans. Circulation . 1988;;78:1128-1134.
23 +
Sigwart U, Puel J, Mirkovitch V, Joffre F, Kappenberger L.  Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med . 1987;;316:701-706.
24 +
Sigwart U, Urban P, Golf S, et al.  Emergency stenting for acute occlusion after coronary balloon angioplasty. Circulation . 1988;;78:1121-1127.
25 +
Simoons ML, Arnold AER, Betrin A, et al.  Thrombolysis with tissue plasminogen activator in acute myocardial infarction: no additional benefit from immediate percutaneous coronary angioplasty. Lancet . 1988;;1:197-203.
26 +
Topol EJ, Califf RM, George BS, et al.  A randomized trial of immediate versus delayed elective angioplasty after intravenous tissue plasminogen activator in acute myocardial infarction. N Engl J Med . 1987;;317:581-588.
27 +
Rothbaum DA, Linnemeier TJ, Landin RJ, et al.  Emergency percutaneous transluminal coronary angioplasty in acute myocardial infarction: a 3-year experience. J Am Coll Cardiol . 1987;;10:264-272.
28 +
Douglas JS Jr, King SB III, Jones EL, Craver JM, Bradford JM, Hatcher CR.  Reduced efficacy of coronary bypass surgery in women. Circulation . 1981;;64( (suppl II) ):II-11-II-16.
29 +
Krumholz HM, Douglas PS, Lauer MS, Pasternak RC.  Selection of patients for coronary angiography and coronary revascularization early after myocardial infarction: is there evidence for a gender bias? Ann Intern Med . 1992;;116:785-790.
30 +
Chaitman BR, Bourassa MG, Davis K, et al.  Angiographic prevalence of high-risk coronary artery disease in patient subsets (CASS). Circulation . 1981;;64:360-367.
31 +
National Center for Health Statistics. Vital Statistics of the United States, Vol II: Mortality, Part B . Washington, DC: US Dept of Health and Human Services, Public Health Service; 1990;. Publication PHS 90-1102.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Cowley MJ, Vetrovec GW, DiSciascio G, Louis SA, Hirsh PD, Wolfgang TC.  Coronary angioplasty of multiple vessels: short-term outcome and long-term results. Circulation . 1985;;72:1314-1320.
2 +
Deligonul U, Vandormael MG, Kern MJ, Zelman R, Galan K, Chaitman BR.  Coronary angioplasty: a therapeutic option for symptomatic patients with two- and three-vessel coronary disease. J Am Coll Cardiol . 1988;;11:1173-1179.
3 +
Bell MR, Bailey KR, Reeder GS, LaPeyre AC III, Holmes DR Jr.  Percutaneous transluminal angioplasty in patients with multi-vessel coronary disease: how important is complete revascularization for cardiac event-free survival? J Am Coll Cardiol . 1991;;16:553-562.
4 +
Parisi AF, Folland ED, Hartigan P, the Veterans Affairs ACME Investigators.  A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. N Engl J Med . 1992;;326:10-16.
5 +
Detre K, Holubkov R, Kelsey S, et al.  Percutaneous transluminal coronary angioplasty in 1985-1986 and 1977-1981: the National Heart, Lung, and Blood Institute Registry. N Engl J Med . 1988;;318: 265-270.
6 +
Gruentzig AR, King SB III, Schlumpf M, Siegenthaler W.  Long-term follow-up after percutaneous transluminal coronary angioplasty: the early Zurich experience. N Engl J Med . 1987;;316:1127-1132.
7 +
Cowley MJ, Mullin SM, Kelsey S, et al.  Sex differences in early and long-term results of coronary angioplasty in the NHLBI PTCA Registry. Circulation . 1985;;71:90-97.
8 +
Ellis SG, Roubin GS, King SB III, et al.  In-hospital cardiac mortality after acute closure after coronary angioplasty: analysis of risk factors from 8207 procedures. J Am Coll Cardiol . 1988;;11:211-216.
9 +
Holmes DR Jr, Holubkov R, Vlietstra RE, et al.  Comparison of complications during percutaneous transluminal coronary angioplasty from 1977 to 1981 and from 1985 to 1986: the National Heart, Lung, and Blood Institute Registry. J Am Coll Cardiol . 1988;;12:1149-1155.
10 +
McEniery PT, Hollman J, Knezinek V, et al.  Comparative safety and efficacy of percutaneous transluminal coronary angioplasty in men and in women. Cathet Cardiovasc Diagn . 1987;;13:364-371.
11 +
Tobin JN, Wassertheil-Smoller S, Wexler JP, et al.  Sex bias in considering coronary bypass surgery. Ann Intern Med . 1987;;107:19-25.
12 +
Ayanian JZ, Epstein AM.  Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med . 1991;;325:221-225.
13 +
Steingart RM, Packer M, Hamm P, et al.  Sex differences in the management of coronary artery disease. N Engl J Med . 1991;;325:226-230.
14 +
Khan SS, Nessim S, Gray R, Czer LS, Chaux A, Matloff J.  Increased mortality of women in coronary artery bypass surgery: evidence for referral bias. Ann Intern Med . 1990;;112:561-567.
15 +
Fisher LD, Ward Kennedy J, Davis KB, et al.  Association of sex, physical size, and operative mortality after coronary artery bypass in the Coronary Artery Surgery Study (CASS). J Thorac Cardiovasc Surg . 1982;;84:334-341.
16 +
Loop FD, Golding LR, MacMillan JP, Cosgrove DM, Lytle BW, Sheldon WC.  Coronary artery surgery in women compared with men: analyses of risks and long-term results. J Am Coll Cardiol . 1983;;1:383-390.
17 +
Campeau L.  Grading of angina pectoris. Circulation . 1976;;54:522-523.
18 +
Vlietstra RE, Holmes DR Jr, Smith HC, Hartzler GO, Orszulak TA.  Percutaneous transluminal coronary angioplasty: initial Mayo Clinic experience. Mayo Clin Proc . 1981;;56:287-293.
19 +
Vlietstra RE, Bresnahan JF, Holmes DR Jr.  Coronary balloon angioplasty.  In: Holmes DR Jr, Vlietstra RE, eds. Interventional Cardiology . Philadelphia, Pa: FA Davis Co Publishers; 1989;:64-66.
20 +
Simpson JB, Baim DS, Robert EW, Harrison DC.  A new catheter system for coronary angioplasty. Am J Cardiol . 1982;;49:1216-1222.
21 +
Turi ZG, Campbell CA, Gottimukkala MV, Kloner RA.  Preservation of distal coronary perfusion during prolonged balloon inflation with an autoperfusion angioplasty catheter. Circulation . 1987;; 75:1273-1280.
22 +
Quigley PJ, Hinohara T, Phillips HR, et al.  Myocardial protection during coronary angioplasty with an autoperfusion balloon catheter in humans. Circulation . 1988;;78:1128-1134.
23 +
Sigwart U, Puel J, Mirkovitch V, Joffre F, Kappenberger L.  Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med . 1987;;316:701-706.
24 +
Sigwart U, Urban P, Golf S, et al.  Emergency stenting for acute occlusion after coronary balloon angioplasty. Circulation . 1988;;78:1121-1127.
25 +
Simoons ML, Arnold AER, Betrin A, et al.  Thrombolysis with tissue plasminogen activator in acute myocardial infarction: no additional benefit from immediate percutaneous coronary angioplasty. Lancet . 1988;;1:197-203.
26 +
Topol EJ, Califf RM, George BS, et al.  A randomized trial of immediate versus delayed elective angioplasty after intravenous tissue plasminogen activator in acute myocardial infarction. N Engl J Med . 1987;;317:581-588.
27 +
Rothbaum DA, Linnemeier TJ, Landin RJ, et al.  Emergency percutaneous transluminal coronary angioplasty in acute myocardial infarction: a 3-year experience. J Am Coll Cardiol . 1987;;10:264-272.
28 +
Douglas JS Jr, King SB III, Jones EL, Craver JM, Bradford JM, Hatcher CR.  Reduced efficacy of coronary bypass surgery in women. Circulation . 1981;;64( (suppl II) ):II-11-II-16.
29 +
Krumholz HM, Douglas PS, Lauer MS, Pasternak RC.  Selection of patients for coronary angiography and coronary revascularization early after myocardial infarction: is there evidence for a gender bias? Ann Intern Med . 1992;;116:785-790.
30 +
Chaitman BR, Bourassa MG, Davis K, et al.  Angiographic prevalence of high-risk coronary artery disease in patient subsets (CASS). Circulation . 1981;;64:360-367.
31 +
National Center for Health Statistics. Vital Statistics of the United States, Vol II: Mortality, Part B . Washington, DC: US Dept of Health and Human Services, Public Health Service; 1990;. Publication PHS 90-1102.

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