ABC | Volume 111, Nº4, Octuber 2018

Original Article de Souza e Silva et al Percutaneous coronary intervention in the State of Rio de Janeiro Arq Bras Cardiol. 2018; 111(4):553-561 Figure 3 – Kaplan-Meier estimates of survival for patients submitted to one single percutaneous coronary intervention (PCI) paid by SUS between 1999 and 2010 according to PCI type. 100 80 60 40 20 0 0 5 years 10 years 15 years Analysis time Survival probability (%) PCI without stent placement PCI with stent placement Primary PCI PCI without stent placement PCI with stent placement Primary PCI Patients at risk 6967 11600 696 (1210) (1892) (148) 5684 7614 335 (947) (692) (27) 4526 647 20 (490) (22) (0) 492 0 0 The 2015 life table shows that in the general population in the state of RJ, women´s live expectancy is higher than men´s at the age groups addressed in this study: 22.6 and 18.8 years for women and men aged 60 years old, respectively, and 9.1 and 8.0 years for women and men aged ≥ 80 years old, respectively. 25 However, it is not known if the survival of Brazilian men and women with coronary artery disease differ. In a study conducted in Norway with patients admitted to a hospital who had suffered a first episode of acute myocardial infarction, no age-adjusted sex-specific differences were observed in 28‑day, one-year or 10-year case-fatality rate for patients aged <60 years. 26 However, in patients aged≥60 years, for the same periods, a lower case-fatality rate was evidenced in women. In Sweden, women that presented myocardial infarction, whether or not admitted to a hospital, over a 23-year period showed a 9% higher survival rate. 27 Several attempts have been made in order to explain these conflicting results, such as biological attributes and social behaviors; however, those explanations are largely speculative. Regardless the causes, based on our results it seems that PCI reduces the gap in survival rates favoring women over men mainly among the cases involving younger patients (<50 years), and after some years following the intervention women have again a better probability of survival as observed in the general population. As in other studies, here also older individuals had lower probabilities of survival than younger ones. The New York State Angioplasty Registry’s data of patients submitted to emergency or elective PCI showed that when stratified by age group, overall in-hospital mortality rate in patients aged ≥ 80 years old was threefold higher than in patients aged 60-79 years, and sevenfold higher than in patients aged <60 years. 28 A collaborative analysis from ten randomized trials, 29 with a median follow-up of surviving patients of 5.9 years showed a 16% overall mortality rate of patients submitted to PCI done with balloon angioplasty or with bare-metal stents. As by age group, mortality rate in patients aged <55, 55-64 and ≥ 65 years old was 8%, 14% and 20%, respectively, showing a gradual effect of age in mortality. Regarding the differences in outcomes after PCI with or without stent placement, while there is no doubt that bare-metal stent placement reduces the rate of restenosis and revascularization, 30 most RCTs have failed to show any advantage as to mortality rates of bare-metal stent placement over simple balloon angioplasty. The BENESTENT group has found no differences in in-hospital mortality and mortality rates at 7 months, one year and 5 years, in patients with stable angina submitted to PCI-S or simple balloon angioplasty. 31,32 A meta-analysis of RCTs comparing both procedures in the setting of non-acute coronary artery disease have shown just a small benefit in overall mortality rates with the routine use of stent, corresponding to an average of three, five and six additional lives saved per 1,000 patients treated at 30 days, 6 months and 12 months, respectively. 33 However, it was not possible to guarantee that this small additional benefit related to mortality rates was due to stent placement instead of to unbalanced co-interventions once more aggressive post‑intervention therapy was observed in the stent group. As for acute myocardial infarction, Suryapranata et al. 34 showed 558