Sex Differences in 1-Year Health Status Following Percutaneous Coronary Intervention in Patients Without Acute Myocardial Infarction: Results From the China PEACE Prospective Study

Xin Zheng, Rachel P Dreyer, Jeptha P Curtis, Shuling Liu, Xiao Xu, Xueke Bai, Xi Li, Haibo Zhang, Siming Wang, Frederick A Masoudi, John A Spertus, Jing Li, Harlan M Krumholz, China PEACE Collaborative Group, Xin Zheng, Rachel P Dreyer, Jeptha P Curtis, Shuling Liu, Xiao Xu, Xueke Bai, Xi Li, Haibo Zhang, Siming Wang, Frederick A Masoudi, John A Spertus, Jing Li, Harlan M Krumholz, China PEACE Collaborative Group

Abstract

Background Sex differences in health status outcomes after percutaneous coronary intervention among patients without acute myocardial infarction are not well described. Methods and Results A total of 2237 patients (33.4% women) without acute myocardial infarction undergoing percutaneous coronary intervention were enrolled from 39 Chinese tertiary hospitals in the PEACE (China Patient-centered Evaluative Assessment of Cardiac Events) prospective percutaneous coronary intervention study. Data were collected immediately before and 1 year following percutaneous coronary intervention. Health status was measured using the disease-specific Seattle Angina Questionnaire (SAQ) Angina Frequency and Quality of Life domains, as well as the SAQ Summary Score. Among the study population, women were older, more often single, had lower levels of education, and had a higher prevalence of cardiac risk factors such as hypertension and diabetes mellitus. Women had lower mean 1-year SAQ Angina Frequency scores (mean±SD, 91.0±17.3 versus 93.9±13.3; P<0.01), SAQ Quality of Life scores (mean±SD, 67.3±23.0 versus 70.6±21.6; P<0.01), and SAQ Summary Scores (mean±SD, 81.6±13.8 versus 84.8±11.9; P<0.01), a difference of marginal clinical significance that persisted after multivariable adjustment. A slightly larger improvement in the SAQ Summary Score was observed in women as compared with men (20.9±22.6 versus 18.5±21.3; P=0.007) in unadjusted analysis. However, women were less likely to achieve clinically significant improvement in SAQ Angina Frequency (adjusted odds ratio, 0.67; 95% CI, 0.45-1.00) and SAQ Quality of Life (adjusted odds ratio, 0.73; 95% CI, 0.56-0.96) after adjustment. Conclusions There were no clinically significant differences in 1-year health status outcomes and improvement in health status by sex among patients without acute myocardial infarction following percutaneous coronary intervention. However, female sex was associated with poorer 1-year health status and a lower likelihood of experiencing clinically improvement in health status. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01624922.

Keywords: health status; percutaneous coronary intervention; sex differences.

Figures

Figure 1
Figure 1
Mean Seattle Angina Questionnaire (SAQ) scores stratified by sex at baseline and 1 year.
Figure 2
Figure 2
Distribution of Seattle Angina Questionnaire (SAQ) scores stratified by sex at baseline, 1 year, and the change form baseline to 1 year.
Figure 3
Figure 3
Independent effect of sex on health status at 1 year post‐PCI among patients without AMI. (A) Possibility of being free of angina (Seattle Angina Questionnaire Angina Frequency score=100 vs <100). (B) Seattle Angina Questionnaire Quality of Life score. (C) Seattle Angina Questionnaire Summary Score. AMI indicates acute myocardial infarction; OR, odds ratio; PCI, percutaneous coronary intervention; SAQ, Seattle Angina Questionnaire.
Figure 4
Figure 4
Independent effect of sex on clinically significant improvement in health status from baseline to 1 year post‐PCI among the patients without AMI. (A) Possibility of achieving clinically significant improvement in SAQ‐AF score; (B) Possibility of achieving clinically significant improvement in SAQ‐QoL score. Seattle Angina Questionnaire summary score. AMI indicates acute myocardial infarction; OR, odds ratio; PCI, percutaneous coronary intervention; SAQ, Seattle Angina Questionnaire; SAQ‐AF, Seattle Angina Questionnaire Angina Frequency; SAQ‐QoL, Seattle Angina Questionnaire Quality of Life.

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