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Original Articles

Significantly Improved Vascular Complications Among Women Undergoing Percutaneous Coronary Intervention

A Report From the Northern New England Percutaneous Coronary Intervention Registry

Bina Ahmed, MD; Winthrop D. Piper, MD; David Malenka, MD; Peter VerLee, MD; John Robb, MD; Thomas Ryan, MD; Michael Herne, MD; William Phillips, MD and Harold L. Dauerman, MD

From the Division of Cardiology (B.A., H.L.D.), University of Vermont College of Medicine, Burlington, Vt; Section of Cardiology (W.D.P., D.M., J.R.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Division of Cardiology (P.V.), Eastern Maine Medical Center, Bangor, Me; Division of Cardiology (T.R.), Maine Medical Center, Portland, Me; Catholic Medical Center (M.H.), Manchester, NH; and Central Maine Medical Center (W.P.), Lewiston, Me.

Correspondence to Bina Ahmed, MD, Division of Cardiology, McClure 1, University of Vermont/Fletcher Allen Health Care, 111 Colchester Avenue, Burlington, VT 05401. E-mail bina.ahmed{at}vtmednet.org

Received February 24, 2009; accepted July 27, 2009.

Background— Women are at a higher risk for bleeding/vascular complications (VC) related to cardiovascular procedures. Although the overall incidence of percutaneous coronary intervention (PCI)-related bleeding/VC has declined, the impact of this decline, specifically in women, is unknown.

Methods and Results— We studied 13 653 female and 32 334 male consecutive cases, from 2002 to 2007, in the Northern New England PCI Registry. We sought to (1) compare absolute rates of bleeding/VC in women and men over time, (2) define predictors of bleeding/VC in women and men undergoing PCI, and (3) trend the impact of female gender in predicting bleeding/VC over time. Bleeding/VC was defined as any access-site vessel injury requiring surgical intervention or bleeding requiring transfusion. The overall risk of bleeding/VC was significantly higher in women versus men (4.5±1.3% versus 1.6±0.5%; P<0.004). Over time, there was a significant (P<0.001) 50% decrease in absolute bleeding/VC rates in both women and men. After adjustment for baseline differences, female gender remained a significant predictor of increased risk in 2007 (odds ratio, 2.6; 95% CI, 1.74 to 3.91). Independent predictors of increased risk of bleeding/VC in women included older age, shock, renal failure, presentation with non-ST-elevation myocardial infraction and larger sheath sizes, whereas the use of fluoroscopy-guided access, closure devices, history of dyslipidemia or prior PCI, and use of bivalirudin were protective.

Conclusion— Women undergoing PCI have had a significant decline in bleeding/VC rates during the last 6 years. Despite the improvement in procedural safety, female gender continues to be associated with a >2-fold risk of bleeding/VC compared with men.

Key Words: vascular complication • gender • PCI

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