Sex differences in health status after elective percutaneous coronary intervention

Background

Women with coronary artery disease (CAD) often report worse health-related quality of life (HRQoL) compared to men. However, the longitudinal effect of elective percutaneous coronary intervention (PCI) on HRQoL between women and men is less studied.

Purpose

The aim of this study was to investigate the effect of elective PCI on patients’ health status measured by HRQoL instruments, and to determine whether there are differences in improvement of symptoms and HRQoL between women and men.

Methods

A total of 88 women (29.3%) and 212 (70.7%) men undergoing elective PCI self-assessed their HRQoL using both the disease-specific seven-item Seattle Angina Questionnaire (SAQ-7) and the generic HRQoL 15D instrument at baseline and at one and 12 months after PCI. We used unadjusted and adjusted linear mixed models to compare the groups.

Results

Women were almost three years older, had lower glomerulus filtration rate, and had less severe CAD compared to men. At baseline, women reported more angina-related physical limitations (SAQ-PL) (p=0.003). Otherwise, both instrument scores (SAQ-7 and 15D) were comparable between the sexes.

At one month, both sexes improved their SAQ-7 and 15D scores, with statistically significant and clinically important improvements. Excellent health status (SAQ-7 score) was more common among men (62.8% vs. 75.5%). Both groups improved their SAQ-AF clinically importantly, whereas women were less often angina-free (32.2% vs. 52.4%, p=0.017) (Figure 1).

At 12 months, both instrument scores remained improved in women and men. Fair health status (SAQ-7) was more common among women (11.9% vs. 6.8%), while men reported their health status more often as excellent (58.3% vs. 75.2%, respectively) (p=0.027). Moreover, women had worse SAQ-PL (p=0.013), and they were less often free of angina (38.8% vs. 48.6%, p=0.020). In both groups, the 15D score started to decline but remained improved (Figure 2). There was no difference in 12-month improvement in 15D between sexes (p=0.852). In addition, there were no differences between sexes in major adverse cardiac or cerebrovascular events during the 12-month follow-up.

Conclusions

Both women and men reported significant improvements in disease-specific and generic HRQoL following elective PCI. However, at 12 months, women showed less improvement in the SAQ-7, SAQ-PL, and SAQ-AF scores than men.