THE CHANGING IN-HOSPITAL MORTALITY OF WOMEN UNDERGOING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Objective.-To compare in-hospital mortality among women and men undergoing percutaneous transluminal coronary angioplasty (PTCA) and determine whether mortality differences have changed recently. Design.-A retrospective cohort study. Setting.-Tertiary referral institution. Patients.-Consecutive series of 3557 patients (27% women) who underwent 4071 PTCA procedures. Two cohorts were analyzed: patients treated between 1979 and 1987 (n=1970) and those treated between 1988 and 1990 (n=2101). Main Outcome Measures.-In-hospital and periprocedural mortality. Results.-Women were older than men (P<.001) and more had class III or IV angina (P<.001), unstable angina (P<.001), angina at rest (P<.001), cardiac failure (P<.001), and diabetes mellitus, hypertension, and hypercholesterolemia (P<.001). The PTCA was successful in 85% of women and 86% of men with an in-hospital mortality rate of 4.2% and 2.7%, respectively (P=.005). No significant change in mortality occurred in men between the early (2.2%) and late (3.1%) eras in contrast to a significant increase among women, 2.9% to 5.4% (P=.04). Periprocedural mortalities for women and men between 1979 and 1987 were 1.0% and 1.2% (P=not significant) and between 1988 and 1990 were 2.9% and 1.4% (P=.02), respectively. The multivariate odds ratio of in-hospital mortality for women vs men was 1.51 (95% confidence interval, 1.00 to 2.29; P=.05), although six other baseline variables were more powerful predictors of in-hospital mortality. Accounting for body surface area resulted in no significant association between gender and in-hospital mortality. Periprocedural mortality was not independently associated with gender. Conclusions.-In-hospital mortality among women has increased in recent years, but their higher mortality compared with men is related more to the severity of their underlying disease rather than gender alone.