Coronary Revascularization in Women

Abstract

Historically, mortality rates have been higher in women than in men for both PCI and CABG. Recent registries and studies have shown that women have mortality rates similar to men after correcting for age and comorbidities. The gender gap is narrowing with respect to outcomes for women with both PCI and CABG. Revascularization with PCI and CABG in women with stable angina (SA), unstable angina (UA), non ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI) will all be reviewed in light of the most recent studies and registries. IntroductionAccording to the American Heart Association (AHA), 150 000 women had coronary artery bypass graft surgery (CABG), and 360 000 women had percutaneous coronary intervention (PCI) in 2007. Even with these numbers, only 33% of all PCI procedures were performed in women. 1 Historically, mortality rates have been higher in women than in men for both PCI and CABG. 2 Some possible reasons for these results have been that women have more comorbidities such as hypertension (HTN), diabetes mellitus (DM), left ventricular dysfunction, and present at a later age compared to men. Smaller blood vessels and underutilization of practice guideline recommendations have also been cited as reasons for the disparity of outcomes in women. Women have less obstructive coronary artery disease (CAD) than men when presenting with the same diagnosis for angiography. However, recent registries and studies have shown that women have mortality rates similar to men after correcting for age and comorbidities. Revascularization with PCI and CABG in women with stable angina, unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI) will all be reviewed in light of the most recent studies and registries.

Gender Differences in Presentation, Coronary Intervention, and Outcomes of 28,985 Acute Coronary Syndrome Patients in Victoria, Australia

“…However, while appreciating the risk of microvascular CAD in women, it is also important to remember that a substantial proportion of women with ACS symptoms do have male-pattern obstructive CAD (Gulati et al, 2012), so it can be argued that the frequent decision not to refer women for angiography means that their underlying coronary anatomy is not assessed and that opportunities to revascularize eligible women may be missed (Banks, 2008). Recent systematic reviews have confirmed the benefit of an early invasive therapy in women with ACS, while noting the under-representation of women in many trials and the problem of limited reporting of results by gender (Dolor et al, 2012;Lundberg & King, 2012).…”

The Association of Gender to Cardiovascular Outcomes After Coronary Artery Revascularization in Patients With End‐Stage Renal Disease

“…Prior studies have noted an increased number of baseline comorbidities in women when compared to men. 1,2,5 The BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) study 22 included 22 725 patients with normal renal function and showed that, despite an increased baseline comorbidity profile, 5-year outcomes were similar. Our finding of an increased baseline comorbidity profile in the ESRD cohort should not be surprising.…”

“…Advancing age and an increase in the number of baseline comorbidities have been noted in women with normal renal function referred for coronary revascularization by PCI or CABG . Whether this differential comorbidity profile between men and women explains the variations in outcomes in patients with ESRD is still under debate . More gender‐specific research is needed …”

“…comorbidity profile between men and women explains the variations in outcomes in patients with ESRD is still under debate. 2,3,5,6 More gender-specific research is needed. 7 -9 The double threat of inadequate recruitment of women and the exclusion of patients with advanced kidney disease, especially those with ESRD into clinical trials, 10 -12 have led to large gaps of knowledge in this area.…”

Impact of gender on mid-term prognosis of patients undergoing coronary artery bypass grafting

“…However, data on sex differences in clinical outcomes after CABG are controversial, and there have been limited data focusing on long-term outcomes. Several studies reported that women suffering from coronary heart disease tend to have more co-morbidities and are more likely to present with a severe form of cardiogenic shock that requires urgent or emergent CABG compared with men [ 3 – 5 ]. Moreover, women have relatively small body surface area, and thus smaller coronary vessels.…”