Persistent sex disparities in clinical outcomes with percutaneous coronary intervention: Insights from 6.6 million PCI procedures in the United States
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Persistent sex disparities in clinical outcomes with percutaneous coronary intervention : Insights from 6.6 million PCI procedures in the United States. / Potts, Jessica; Sirker, Alex; Martinez, Sara C; Gulati, Martha; Alasnag, Mirvat; Rashid, Muhammad; Kwok, Chun Shing; Ensor, Joie; Burke, Danielle L; Riley, Richard D; Holmvang, Lene; Mamas, Mamas A.
I: PLoS ONE, Bind 13, Nr. 9, e0203325, 2018.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Persistent sex disparities in clinical outcomes with percutaneous coronary intervention
T2 - Insights from 6.6 million PCI procedures in the United States
AU - Potts, Jessica
AU - Sirker, Alex
AU - Martinez, Sara C
AU - Gulati, Martha
AU - Alasnag, Mirvat
AU - Rashid, Muhammad
AU - Kwok, Chun Shing
AU - Ensor, Joie
AU - Burke, Danielle L
AU - Riley, Richard D
AU - Holmvang, Lene
AU - Mamas, Mamas A
PY - 2018
Y1 - 2018
N2 - 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.
AB - 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.
KW - Age Factors
KW - Aged
KW - Comorbidity/trends
KW - Female
KW - Healthcare Disparities/statistics & numerical data
KW - Hospital Mortality/trends
KW - Humans
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Non-ST Elevated Myocardial Infarction/surgery
KW - Percutaneous Coronary Intervention/adverse effects
KW - Postoperative Complications/epidemiology
KW - Retrospective Studies
KW - Sex Factors
KW - Treatment Outcome
KW - United States/epidemiology
U2 - 10.1371/journal.pone.0203325
DO - 10.1371/journal.pone.0203325
M3 - Journal article
C2 - 30180201
VL - 13
JO - PLoS ONE
JF - PLoS ONE
SN - 1932-6203
IS - 9
M1 - e0203325
ER -
ID: 216569042