Sex-specific Differences In Coronary Artery Stenting

There are several sex-specific differences in baseline characteristics, clinical course and relative weight of prognostic factors in coronary artery stenting for women compared to men.

One-year outcomes of both men and women with coronary artery disease (CAD), however, are similar, a German study indicates.

A second study from the United States suggests that elective stenting improves clinical outcomes after percutaneous coronary revascularization in a wide variety of lesion types and clinical settings.

Elective stenting is preferable to provisional stenting or balloon angioplasty alone, Mayo Clinic researchers point out.

In the first study, Munich researchers used an inception cohort study to examine whether there are sex-based differences in both prognostic factors and outcomes among CAD patients undergoing stenting.

A consecutive series of 1,001 women and 3,263 men with CAD received stents at two tertiary referral institutions between May 1992 and December 1998. Investigators compared rates of death and non-fatal myocardial infarction (MI) by sex at 30 days and at one year.

Women undergoing stenting were found to be older, at a mean of 69 years, than men, who had a mean age of 63 years. Women were more likely to have diabetes, arterial hypertension or hypercholesterolemia. They had less extensive CAD, less frequent histories of MI, and better preserved left ventricular function.

At 30-day outcome, women had an excess combined risk of death or non-fatal MI of 3.1 percent, compared to 1.8 percent in men. Their multivariate-adjusted hazard rate was found to be 2.02 compared to men.

At one-year outcome, rates were similar between women (6.0 percent) and men (5.8 percent).
There was a sex difference in the strongest prognostic factors at baseline as well. In women, it was diabetes; in men, it was age.

In the second study, Mayo Clinic researchers used a search of the literature from 1990 through January 2000 to review evidence supporting the widespread use of intracoronary stents. They reviewed studies assessing the immediate and long-term effects of stenting on patients undergoing percutaneous coronary revascularization.

Data synthesis showed that coronary artery stenting increases the safety of interventional procedures. Stenting increases procedure success rates and decreases the need for emergency coronary artery bypass graft surgery.

“Intracoronary stents have become an essential component of catheter-based treatment of CAD,” the researchers concluded.

Editorialist Dr. A. Michael Lincoff, Cleveland Clinic Foundation, says that “enthusiasts of stenting may erroneously equate excellent angiographic results achieved by this technique with optimal clinical outcomes, thereby withholding effective new adjunct pharmacologic therapies from patients with stents.”

He suggests this might occur because doctors are “under the misconception that no further improvements in outcome are possible.”

Clinical benefit from stenting has been confined to reductions in recurrent ischemia or a need for revascularization, Dr. Lincoff notes. He points to higher rates of long-term mortality with stenting compared with balloon angioplasty during acute MI.

JAMA, 2000, 284: (i) 1799-1805; (ii) 1828-1836; (editorial) 1839-1841