Gender Differences in Percutaneous Coronary Intervention Outcomes from a Clinical Registry of 59,000 PCIs.

摘要

Bivalirudin and device closure has made a dramatic impact on outcomes for patients at high risk of major bleeding. There has been a significant gap in major bleeding rates for women undergoing PCI compared to men with women having up to four times the rate of bleeding. The primary aim of the current study was to determine whether a combination of bivalirudin and device for access closure narrows the gender gap in bleeding outcomes. This study was conducted from a multi-center, prospective registry from a national health system in the United States. The ACC data captured was for all comers and sent to a central repository. This study examined data from procedures in the registry between June 1, 2009 and June 30, 2012. The analysis was conducted using the 58,862 PCI procedures. Women had higher rates of bleeding (4.6%) then men (1.9%). Adjusting for confounding factors in the multiple regression analysis we observed that gender remained the strongest, independent predictor of bleeding [R2 = 0.77, OR=2.4 (CI: 2.0 - 2.7), p<0.001]. This model also demonstrated that even with the risk of female gender, bivalirudin and device closure was the strongest independent predictor of reduction in bleeding [R2=0.43, OR=0.38 (CI: 0.24 -0.60), p<0.001]. The gender gap in bleeding narrowed to 0.4% with the combined strategy. In the era of bivalirudin, the gender gap in bleeding outcomes is practically eliminated.