Influence of Age and Gender on Clinical Outcomes Following Percutaneous Coronary Intervention for Acute Coronary Syndromes

Background Gender and age are non-modifiable factors influencing clinical outcomes in acute coronary syndromes (ACS). There is evidence that coronary artery disease pathophysiology varies in women. We therefore evaluated the effect of age and gender on clinical outcomes in patients with ACS undergoing percutaneous coronary interventions (PCI). Methods Among 3178 (25% female) consecutive ACS patients who underwent PCI at Liverpool Hospital, Sydney from 2003 to 2010, using femoral access in 98% of cases, we determined late events including mortality, myocardial infarction and bleeding according to Bleeding Academic Research Consortium (BARC) criteria. Results Females compared with males were older (median 68 vs. 60 years; p<0.001), and were more likely to have diabetes (30% vs. 22% p<0.001), hypertension (62% vs. 49%, p<0.001), anaemia (26% vs. 15%, p<0.001), and renal impairment (43% vs. 20%, p<0.001); they were more likely to be non-smokers (19% vs. 30%, p<0.001). Females had less class B2/C lesions (64% vs. 68%, p=0.048), but had more calcified lesions (20% vs. 11%, p<0.001), and smaller stent diameters (2.75[2.5-3.0] vs. 3.0[2.75-3.5] mm, p<0.001). Females had higher three year mortality rates (11% vs. 7.0%, p=0.001), and more type 2-5 BARC bleeding post-PCI (22% vs. 16%, p=0.003). Among patients under 55 years (n=988), mortality and bleeding were higher in females (6.0% vs. 3.0%, p=0.028) and (26% vs. 14%, p=0.001) respectively. There was no effect of gender on mortality or bleeding in patients 55 years and over. However, on multivariable stepwise regression analysis, female gender was not an independent predictor of mortality, but was a significant predictor of bleeding (OR=1.84 [95% CI: 1.38-2.45], p<0.001). Conclusion Bleeding and mortality were higher in younger females with ACS who underwent PCI. While females had more post-PCI bleeding events, which were associated with late mortality, gender per se was not an independent predictor for mortality.