Potts, JE, Sirker, A, Martinez, S, Gulati, M, Alasnag, M, Rashid, M, Kwok, CS ORCID: https://orcid.org/0000-0001-7047-1586, Ensor, J ORCID: https://orcid.org/0000-0001-7481-0282, Burke, D, Riley, R ORCID: https://orcid.org/0000-0001-8699-0735, Holmvang, L and Mamas, M ORCID: https://orcid.org/0000-0001-9241-8890 (2018) Persistent sex disparities in clinical outcomes with percutaneous coronary intervention: Insights from 6.6 million PCI precedures in the United States. PLoS ONE, 13 (9).

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Abstract

Background
Prior studies have reported inconsistencies in the baseline risk profile, comorbidity burden and their association with clinical outcomes in women compared to men. More importantly, there is limited data around the sex differences and how these have changed over time in contemporary percutaneous coronary intervention (PCI) practice.

Methods and results
We used the Nationwide Inpatient Sample to identify all PCI procedures based on ICD-9 procedure codes in the United States between 2004–2014 in adult patients. Descriptive statistics were used to describe sex-based differences in baseline characteristics and comorbidity burden of patients. Multivariable logistic regressions were used to investigate the association between these differences and in-hospital mortality, complications, length of stay and total hospital charges. Among 6,601,526 patients, 66% were men and 33% were women. Women were more likely to be admitted with diagnosis of NSTEMI (non-ST elevation acute myocardial infarction), were on average 5 years older (median age 68 compared to 63) and had higher burden of comorbidity defined by Charlson score ≥3. Women also had higher in-hospital crude mortality (2.0% vs 1.4%) and any complications compared to men (11.1% vs 7.0%). These trends persisted in our adjusted analyses where women had a significant increase in the odds of in-hospital mortality men (OR 1.20 (95% CI 1.16,1.23) and major bleeding (OR 1.81 (95% CI 1.77,1.86).

Conclusion
In this national unselected contemporary PCI cohort, there are significant sex-based differences in presentation, baseline characteristics and comorbidity burden. These differences do not fully account for the higher in-hospital mortality and procedural complications observed in women.

Item Type: Article
Additional Information: This is the final published version (version of record), which was published by Public Library of Science and available via https://doi.org/10.1371/journal.pone.0203325 - please refer to any applicable terms of use of the publisher.
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 06 Sep 2018 11:43
Last Modified: 05 Mar 2019 16:12
URI: https://eprints.keele.ac.uk/id/eprint/5290

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