Comparative safety and efficacy of percutaneous transluminal coronary angioplasty in men and in women

McEniery, Paul T.; Hollman, Jay; Knezinek, Valerie; Dorosti, Khosrow; Franco, Irving; Simpfendorfer, Conrad; Whitlow, Patrick L.

doi:10.1002/ccd.1810130602

Cited by 57 publications

(21 citation statements)

References 9 publications

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“…In the NHLBI registry [3], women had a lower angioplasty success rate and higher mortality. Simi Percutaneous Translum inal Coronary Angioplasty larly both McEniery et al [4] and more recently Weintraub ct al. [5] reported higher angioplastv-related mortal ity in women.…”

Section: Discussionmentioning

confidence: 99%

“…Continuous improvement in equipment and operator ex perience permits angioplasty in a wide variety of patients; currently this is the most common revascularization tech nique [1,2], Previous reports describe the success and complication rates of coronary angioplasty as related to age and gender [3][4][5][6][7][8][9][10][11][12][13][14][15], Most of these reports describe the experience gained in the early 80s when both the indica tions and the equipment used were different from those in current practice, and the results may not be consistent with contemporary management. This report will exam ine the effect of age and gender on the results of coronary angioplasty using data gathered since 1990.…”

Section: Introductionmentioning

confidence: 99%

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Age- and Gender-Related Differences in Success, Major and Minor Complication Rates and the Duration of Hospitalization after Percutaneous Transluminal Coronary Angioplasty

Rozenman

Gilon²,

Zelingher³

et al. 1996

Cardiology

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This report describes the effect of age and gender on the results of balloon angioplasty using current technique and indications. A consecutive group of 2,067 patients who underwent angioplasty at a single institution after 1990 is described. Angioplastic success was 92.2% and similar among men and women and the various age groups. Sixteen patients (0.8%) died, and mortality among women was significantly higher (1.4 vs. 0.6%, p < 0.001). There were no age or gender differences in the rate of Q-wave myocardial infarction and the need for coronary artery bypass. Minor complications such as groin complications (10.5% women, 5.0% men; p < 0.001) and infections (6.4% women, 3.7% men; p < 0.05) were more common in women, and as a result the duration of hospitalization after angioplasty was longer. The length of hospitalization after angioplasty was longer with advanced age, mainly as a result of higher groin complications (p < 0.001), infections (p < 0.01) and renal failure (p < 0.05). We conclude that using current indications and technique, angioplasty can be performed safely with a high success rate. Mortality is higher among women. The length of hospitalization after angioplasty is longer in women and, at advanced age, due to higher rate of minor complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Age- and Gender-Related Differences in Success, Major and Minor Complication Rates and the Duration of Hospitalization after Percutaneous Transluminal Coronary Angioplasty

Rozenman

Gilon²,

Zelingher³

et al. 1996

Cardiology

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“…The increased in-hospital mortality of women undergoing elective and primary PCI as compared with men, 16 -24 although not consistently observed 13,15,[25][26][27][28][29][30][31][32][33][34] (Figures 1 and 2), appears at least in some studies to represent a complex interplay of clinical factors such as delayed onset of disease, older age, smaller body surface area, and comorbidities at the time of presentation. 35 In contemporary emergency, urgent, or elective stent and drug-eluting stent (DES) clinical trials and registries, adjustments for these factors largely eradicate any sex differences, dispelling the notion of a sex-specific mortality risk.…”

Section: Sex Differences In Outcomes Of Pcimentioning

confidence: 96%

Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women

Lansky¹,

Hochman²,

Ward³

et al. 2005

Circulation

214

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Abstract-More than 1.2 million percutaneous coronary interventions are performed annually in the United States, with only an estimated 33% performed in women, despite the established benefits of percutaneous coronary intervention and adjunctive pharmacotherapy in reducing fatal and nonfatal ischemic complications in acute myocardial infarction and high-risk acute coronary syndromes. This statement reviews sex-specific data on the safety and efficacy of contemporary interventional therapies in women. 1 Despite the fact that more women than men die from cardiovascular disease in the United States, and despite the established benefits of PCI in reducing fatal and nonfatal ischemic complications in patients with acute myocardial infarction and high-risk acute coronary syndromes, only an estimated 33% of annual PCIs are performed in women. [1][2][3][4] In addition, women experience greater delays 5 to intervention and are referred for diagnostic catheterization less frequently than are men. 6 -8 Although suggested reasons for referral differences have included women's older age at presentation, greater risk profile, and increased risk for an adverse procedural outcome, as well as differences in symptoms and pain perception between men and women and lower predictive accuracy of noninvasive testing in women, some evidence suggests a potential sex and race bias. 9 In contrast, once women are referred for cardiac catheterization, revascularization rates and practices are similar to those in men. 10 -12 Recent advances in angioplasty equipment and technique have improved options for patients with smaller coronary and peripheral (access) arteries. In addition, the increased use of stents and adjunctive pharmacotherapy has improved outcomes in both women and men. Nevertheless, women continue to represent 15% to 38% of the population in studies of PCI, and still relatively few sex-or race-specific data exist.The purpose of this statement is to review what is known and not known about PCI in women and to put published data in context with contemporary coronary intervention. It is not the intention of the writing group to give specific treatment recommendations but rather to compile and collate the available sex-specific data on the safety and efficacy of interventional therapies in women. Tables 1 and 3 provide summaries of the findings in women drawn from this literature review, as well as recommendations from previously published American College of Cardiology/American Heart Association (ACC/AHA) guidelines. MethodsThe information in this statement was compiled by systematic literature review. By searching MEDLINE from JanuaryThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perc...

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“…The need for more data concerning outcomes from PCI in women has led the AHA to issue a scientific statement summarizing available studies (169). Compared with men, women undergoing PCI are older and have a higher incidence of hypertension, diabetes mellitus, hypercholesterolemia, and comorbid disease (69,(170)(171)(172)(173)(174). Women also have more UA and a higher functional class of stable angina (Canadian Cardiovascular Society [CCS] class III and IV) for a given extent of disease (175).…”

Section: Womenmentioning

confidence: 99%