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Malcolm R. Bell, MB, BS, FRACP; David R. Holmes, Jr, MD; Peter B. Berger, MD; Kirk N. Garratt, MD; Kent R. Bailey, PhD; Bernard J. Gersh, MB, ChB, DPhil

JAMA. 1993;269(16):2091-2095.

Abstract
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.

(JAMA. 1993;269:2091-2095)

Author Affiliations
From the Division of Cardiovascular Diseases and Internal Medicine (Drs Bell, Holmes, Berger, Garratt, and Gersh) and Department of Health Science Statistics (Dr Bailey), Mayo Clinic and Mayo Foundation, Rochester, Minn.

Footnotes
Presented in part at the 41st annual meeting of the American College of Cardiology, Dallas, Tex, April 14, 1992.

Reprint requests to Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (Dr Bell).

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