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Amanda Jekowsky, American College of Cardiology,
202-375-6645, ajekowsk@acc.org
June
3, 2008
Women Now on Par With Men in PCI Outcomes
Survival has significantly improved, thanks to
new PCI devices, techniques, medications
Women with heart disease have a new reason to feel encouraged
about the future. A study published in the June 17, 2008,
issue of the Journal of the American College of Cardiology
(JACC) shows that angioplasty and stenting—procedures
that are used to open narrowed coronary arteries—are
far more effective in women than they were in the past. Equally
important, women who undergo percutaneous coronary intervention
(PCI) fare just as well as men, both shortly after the procedure
and over the long run.
The study, conducted at the Mayo Clinic in Rochester, MN,
is expected to help dispel the notion that PCI, which has
revolutionized the treatment of coronary artery disease in
men, is less effective in women.
“Women should feel reassured,” said Mandeep Singh,
M.D., M.P.H., an associate professor of medicine and interventional
cardiologist at the Mayo Clinic. “Not only has there
been significant improvement in PCI outcomes over time, women’s
outcomes are similar to those of men.”
The study is likely to reassure physicians as well. “Studies
have demonstrated that women are less likely than men to be
referred for invasive procedures, including coronary angiography
and PCI,” Dr. Singh said. “Raising awareness among
physicians will help us overcome this referral bias. The decision
to refer a patient for PCI should not be influenced by gender.”
Heart disease is the leading cause of death in women, accounting
for some 400,000 deaths each year. In the United States, approximately
1 million PCI procedures are performed annually, some 30 percent
of them in women. Earlier studies showed that PCI was riskier
in women than in men. One factor in the increased risk may
have been that women have smaller arteries, making PCI more
difficult. In addition, women develop heart disease about
a decade later than men do, so they are more likely to have
additional health problems that complicate recovery after
the procedure.
Since the mid-1990s, however, PCI has improved in several
important ways. New stents have been introduced, the administration
of anti-clotting medications has been refined, cardiologists
have developed increasingly sophisticated interventional techniques,
and a host of research has proven the benefits of medications
such as cholesterol-lowering drugs, beta blockers and angiotensin-converting-enzyme
(ACE) inhibitors in preventing future arterial blockages and
heart attacks.
Dr. Singh and his colleagues set out to determine the effect
of these and other improvements on mortality after PCI. For
the new study, the research team analyzed data from 18,885
patients who underwent PCI at the Mayo Clinic between 1979
and 2004. Patients were divided into two groups. The “early”
group comprised 7,904 patients—28 percent of them women—who
were treated between 1979 and 1995. The “recent”
group comprised 10,981 patients—31 percent of them women—treated
between 1996 and 2004.
Women were older than men at the time of PCI, by about five
years, on average. They were also significantly more likely
to have severe or unstable chest pain, diabetes and high blood
cholesterol levels. Nonetheless, the immediate success rate
for PCI was similar in women and men, 89 percent and 90 percent,
respectively.
A more telling statistic, 30-day mortality, improved significantly
over time in both women and men. Among women, 30-day mortality
fell from 4.4 percent in the early group to 2.9 percent in
the recent group (p=0.002). Among men, 30-day mortality fell
from 2.8 percent to 2.2. percent during the same time periods
(p=0.04).
The researchers then analyzed the difference in outcomes
between women and men, this time accounting for the greater
age and incidence of health problems in women. After adjusting
for these risk factors, they found no significant difference
in mortality between women and men either 30 days or one year
after PCI.
“This is very good news for women,” said Robert
F. Wilson, M.D., a professor of interventional cardiology
at the University of Minnesota and co-author of an editorial
on this subject in the same issue of JACC. “Ten years
ago, both coronary angioplasty and bypass surgery were riskier
in women than in men. The physicians at the Mayo Clinic now
report that, when the risks of age and other illnesses are
accounted for, the mortality risk of coronary angioplasty
in women has fallen significantly. Additionally, when factors
such as diabetes and age are taken into account, the risk
of death after angioplasty in women is the same as it is in
men.”
“Over the last decade, we have dramatically improved
the tools used for angioplasty, from new stents to keep the
artery open to blood thinners to prevent clotting and heart
attacks,” he said. “In addition we have learned
enormously from thousands of clinical research studies that
help us determine the best approach to each patient.”
Dr. Singh reports no conflicts of interest related to this
study.
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The American College of Cardiology is leading the way to
optimal cardiovascular care and disease prevention. The College
is a 34,000-member nonprofit medical society and bestows the
credential Fellow of the American College of Cardiology upon
physicians who meet its stringent qualifications. The College
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and guidelines, and is a staunch supporter of cardiovascular
research. The ACC provides professional education and operates
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online at www.acc.org .
The American College of Cardiology (ACC) provides these news
reports of clinical studies published in the Journal of
the American College of Cardiology as a service to physicians,
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statements or opinions expressed in these reports reflect
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