Women Have Higher Incidence of Chest Pain After PCI With Drug Eluting Stent

At the first year of follow-up from percutaneous coronary intervention with a drug eluting stent, 16.3% of women had more clinically relevant chest pain vs 10.5% of men.

In a pooled analysis of both TWENTE and DUTCH PEERS studies, clinically relevant chest pain was observed more in women than men, after percutaneous coronary intervention (PCI) with a newer generation drug eluting stent (DES).

Researchers also found that the incidence of cardiovascular events was low and similar for both genders.

A total of 3202 patients were included in the analysis: 871 (27.2%) women were older (67.5 ± 10.2 vs 62.8 ± 10.6 years; P<.001) and had more cardiovascular risk factors such as diabetes, hypertension, and positive family history. Women had more clinically relevant chest pain compared with men at the first year of follow-up (16.3% vs 10.5%; P<.001) and again at the second year of follow-up (17.2% vs 11.1%; P<.001).

“Since the introduction of DES in the clinical arena, little attention has been paid to the assessment of residual complaints following PCI, such as chest pain…and the potential gender differences thereof,” researchers noted.

Target vessel failure, the primary end point of TWENTE and DUTCH PEERS trials, was a composite end point of cardiac death, target vessel-related myocardial infarction (MI), or clinically-indicated target vessel revascularization. Secondary end points included all-cause mortality, any MI, clinically-indicated target lesion revascularization, and stent thrombosis.

At 2 years, rates of death, MI, revascularization, stent thrombosis, patient-oriented composite end point (POCE) were similar for both genders: death (4.5% vs 3.4%; P=.16); MI (3.7% vs 3.9%; P=.72); revascularization (8.5% vs 8.6; P=.91); stent thrombosis (0.5% vs 0.8%; P=.34); POCE (14.8% vs 14.2%; P=.68).

However, women showed a 1.7-fold increased risk for having chest pain during normal daily activities (adjusted odds ratio [aOR]: 1.7; 95% confidence interval [CI]: 1.2-2.4; P=.002) and a 1.8-fold increased risk for having chest pain at rest (aOR: 1.8; 95% CI: 1.3-2.4; P<.001) at 1 year follow-up.

In addition, the higher prevalence of clinically relevant chest pain in women may be related to mechanisms other than obstruction of epicardial coronary arteries.

Researchers acknowledged that one limitation of this pooled analysis is that the TWENTE and DUTCH PEERS trial database was not powered to define outcome differences between genders. Therefore, future clinical trials should account for gender differences, or ideally, perform stratification for gender.


Kok MM, van der Heijden LC, Sen H, et al. Gender difference in chest pain after implantation of newer generation coronary drug eluting stents: a patient-level pooled analysis from TWENTE and DUTCH PEERS. JACC Cardiovasc Interv. 2016. doi:10.1016/j.jcin.2015.10.043.