Treatment Effect of Percutaneous Coronary Intervention in Men Versus Women With ST‐Segment–Elevation Myocardial Infarction

Background Women are less likely to receive primary percutaneous coronary intervention (pPCI) than men. A potential reason is risk aversion because of the worse outcomes with pPCI among women. However, whether pPCI is associated with a comparable mortality benefit in men and women remains unknown. M...

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Autores principales:	Samian Sulaiman, Akram Kawsara, Mohamed O. Mohamed, Harriette G. C. Van Spall, Nadia Sutton, David R. Holmes, Mamas A. Mamas, Mohamad Alkhouli
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	myocardial infarction percutaneous coronary intervention sex differences treatment effect Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/3b23ac8811444b9eacbb5dee45821467
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spelling	oai:doaj.org-article:3b23ac8811444b9eacbb5dee458214672021-11-23T11:36:35ZTreatment Effect of Percutaneous Coronary Intervention in Men Versus Women With ST‐Segment–Elevation Myocardial Infarction10.1161/JAHA.121.0216382047-9980https://doaj.org/article/3b23ac8811444b9eacbb5dee458214672021-09-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.021638https://doaj.org/toc/2047-9980Background Women are less likely to receive primary percutaneous coronary intervention (pPCI) than men. A potential reason is risk aversion because of the worse outcomes with pPCI among women. However, whether pPCI is associated with a comparable mortality benefit in men and women remains unknown. Methods and Results We selected patients admitted with a principal diagnosis of ST‐segment–elevation myocardial infarction in the National Inpatient Sample (2016–2018). We used propensity‐score matching to calculate average treatment effects of pPCI for in‐hospital mortality, major complications, length of stay, and cost. As a sensitivity analysis, we used logit models followed by a marginal command to calculate the average marginal effect. We included 413 500 weighted hospitalizations (30.7% women, 69.3% men). Women had more comorbidities except smoking and prior sternotomy. Compared with men, women were less likely to undergo angiography (81.0% versus 87.0%; adjusted odds ratio [OR], 0.77; 95% CI, 0.74–0.81; P<0.001) or pPCI (74.0% versus 82.0%; adjusted OR, 0.76; 95% CI, 0.73–0.79; P<0.001). There were no significant differences in average treatment effects of pPCI on mortality between men (−8.4% [−9.3% to −7.6%], P<0.001), and women (−9.5% [−10.8% to −8.3%], P<0.001) (P interaction=0.16). This persisted in age‐stratified analyses (≥85, 65–84, 45–64, <45 years) and sensitivity analysis, excluding emergent admissions. The average treatment effects of pPCI on major complications were comparable except for acute stroke, leaving against medical advice, and palliative encounter. There were no differences in the average treatment effects of pPCI on length of stay, but the proportional increase in cost with pPCI was higher in women. Conclusions pPCI results in a comparable reduction in in‐hospital mortality in men and women. Nonetheless, risk‐adjusted rates of pPCI remain lower in women in contemporary US practice.Samian SulaimanAkram KawsaraMohamed O. MohamedHarriette G. C. Van SpallNadia SuttonDavid R. HolmesMamas A. MamasMohamad AlkhouliWileyarticlemyocardial infarctionpercutaneous coronary interventionsex differencestreatment effectDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 18 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	myocardial infarction percutaneous coronary intervention sex differences treatment effect Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	myocardial infarction percutaneous coronary intervention sex differences treatment effect Diseases of the circulatory (Cardiovascular) system RC666-701 Samian Sulaiman Akram Kawsara Mohamed O. Mohamed Harriette G. C. Van Spall Nadia Sutton David R. Holmes Mamas A. Mamas Mohamad Alkhouli Treatment Effect of Percutaneous Coronary Intervention in Men Versus Women With ST‐Segment–Elevation Myocardial Infarction
description	Background Women are less likely to receive primary percutaneous coronary intervention (pPCI) than men. A potential reason is risk aversion because of the worse outcomes with pPCI among women. However, whether pPCI is associated with a comparable mortality benefit in men and women remains unknown. Methods and Results We selected patients admitted with a principal diagnosis of ST‐segment–elevation myocardial infarction in the National Inpatient Sample (2016–2018). We used propensity‐score matching to calculate average treatment effects of pPCI for in‐hospital mortality, major complications, length of stay, and cost. As a sensitivity analysis, we used logit models followed by a marginal command to calculate the average marginal effect. We included 413 500 weighted hospitalizations (30.7% women, 69.3% men). Women had more comorbidities except smoking and prior sternotomy. Compared with men, women were less likely to undergo angiography (81.0% versus 87.0%; adjusted odds ratio [OR], 0.77; 95% CI, 0.74–0.81; P<0.001) or pPCI (74.0% versus 82.0%; adjusted OR, 0.76; 95% CI, 0.73–0.79; P<0.001). There were no significant differences in average treatment effects of pPCI on mortality between men (−8.4% [−9.3% to −7.6%], P<0.001), and women (−9.5% [−10.8% to −8.3%], P<0.001) (P interaction=0.16). This persisted in age‐stratified analyses (≥85, 65–84, 45–64, <45 years) and sensitivity analysis, excluding emergent admissions. The average treatment effects of pPCI on major complications were comparable except for acute stroke, leaving against medical advice, and palliative encounter. There were no differences in the average treatment effects of pPCI on length of stay, but the proportional increase in cost with pPCI was higher in women. Conclusions pPCI results in a comparable reduction in in‐hospital mortality in men and women. Nonetheless, risk‐adjusted rates of pPCI remain lower in women in contemporary US practice.
format	article
author	Samian Sulaiman Akram Kawsara Mohamed O. Mohamed Harriette G. C. Van Spall Nadia Sutton David R. Holmes Mamas A. Mamas Mohamad Alkhouli
author_facet	Samian Sulaiman Akram Kawsara Mohamed O. Mohamed Harriette G. C. Van Spall Nadia Sutton David R. Holmes Mamas A. Mamas Mohamad Alkhouli
author_sort	Samian Sulaiman
title	Treatment Effect of Percutaneous Coronary Intervention in Men Versus Women With ST‐Segment–Elevation Myocardial Infarction
title_short	Treatment Effect of Percutaneous Coronary Intervention in Men Versus Women With ST‐Segment–Elevation Myocardial Infarction
title_full	Treatment Effect of Percutaneous Coronary Intervention in Men Versus Women With ST‐Segment–Elevation Myocardial Infarction
title_fullStr	Treatment Effect of Percutaneous Coronary Intervention in Men Versus Women With ST‐Segment–Elevation Myocardial Infarction
title_full_unstemmed	Treatment Effect of Percutaneous Coronary Intervention in Men Versus Women With ST‐Segment–Elevation Myocardial Infarction
title_sort	treatment effect of percutaneous coronary intervention in men versus women with st‐segment–elevation myocardial infarction
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/3b23ac8811444b9eacbb5dee45821467
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Treatment Effect of Percutaneous Coronary Intervention in Men Versus Women With ST‐Segment–Elevation Myocardial Infarction

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