Journal of Invasive Cardiology

A recently published meta-analysis by Stefanini and colleagues evaluated gender differences in a population pooled from three large randomized trials using DES for coronary artery revascularization (sirolimus-eluting versus paclitaxel-eluting stents for coronary revascularization [SIRTAX]; biolimus-eluting stent with biodegradable polymer versus sirolimus-eluting stent with durable polymer for coronary revascularization [LEADERS]; zotarolimus-eluting versus everolimus-eluting coronary stents [RESOLUTE All-Comers]).³ In this pooled analysis of more than 5000 patients, the authors found that women undergoing PCI are usually older and have more cardiovascular risk factors but a lower degree of angiographic complexity. At 2-year follow-up and after controlling for baseline differences, women undergoing PCI with DES had similar outcomes compared to male patients (Figure 1). There was no difference in rates of cardiac death, myocardial infarction, target lesion revascularization, target vessel revascularization, stent thrombosis, in-stent late loss, or in-segment binary restenosis (Figure 2).³ Prior to this study, the “TAXUS Woman” analysis, which included more than 3000 female patients, showed that women have similar benefits from paclitaxel-eluting stents compared to men, except in high-risk patients, in which women had slightly higher TLR rates.⁴ This was clearly exemplified in other studies that looked at high-risk populations undergoing PCI. In patients with ST-elevation myocardial infarction undergoing primary PCI, female patients had a 2-fold higher rate of mortality than men.¹³ In dialysis-dependent patients undergoing PCI, female gender was independently associated with significantly higher rates of in-hospital mortality (OR, 13.23; 95% CI, 1.55-113.25) and adverse cardiac events (OR, 7.41; 95% CI, 1.81-30.27).¹⁴

Moreover, gender discrepancies in referral for coronary angiography seen in earlier studies of acute coronary syndrome (ACS) patients¹⁵ still exist, with recent data from the Minnesota Heart Survey demonstrating that women with a myocardial infarction (MI) were 27% less likely to undergo cardiac catheterization than their male counterparts (OR, 0.73; 95% CI, 0.57-0.94).¹⁶ Despite lower angiography referral rates in women, revascularization rates are not significantly different between genders. Men, however, are more often referred for surgical revascularization while women, who are more prone to single-vessel disease, are more likely to undergo PCI.^16,17