Gender differences in the outcome of interventional cardiac procedures

Prior studies have reported significant gender differences in the procedural outcomes after elective percutaneous transluminal coronary angioplasty (PTCA). Many of these differences have been explained by the presence of more comorbidities and worse clinical characteristics such as older age, unstable angina, congestive heart failure, diabetes mellitus, and hypertension in women than in men. Moreover, women have a smaller vessel diameter, more coronary tortuosity and different plaque composition compared to men that can lead to a higher dissection rate and a greater number of procedural complications. Although early data on PTCA suggested worse immediate results in women than in men, more recent data suggest that this difference is less marked. The introduction of stents with a low profile and a higher tractability and pushability has allowed the extensive application of these devices even in small and tortuous vessels improving the outcome of PTCA. This improvement has been higher in women than in men leading to the equalization of the immediate outcome in the two sexes, even if the baseline characteristics remain worse in women. In particular, mortality and the need for urgent surgical revascularization have become extremely low without any differences between sexes. However, some authors have still found a higher incidence of complications in the first period after the procedure due to stent thrombosis in the stenting era. For this reason, meticulous antiplatelet treatment should be prescribed and drugs such as glycoprotein IIb/IIIa inhibitors may also be considered advisable to reduce the excess risk in the female population particularly in women with prothrombotic risk factors such as diabetes. At 6 and 12 months similar rates of death, late myocardial infarction, and repeated revascularization have been shown in the two sexes. Coronary stenting and the use of glycoprotein IIb/IIIa inhibitors have also improved the immediate results in patients with acute myocardial infarction (AMI) undergoing primary PTCA. Studies comparing the outcome differences between women and men with AMI and treated with primary PTCA are limited but all suggest that women benefit more than men from this procedure. The in-hospital mortality in patients with AMI is significantly higher in the female than in the male population with a higher incidence of intracranial hemorrhage in women among tissue-type plasminogen activator-treated patients. Vice versa, women and men have a similar or a slightly higher in-hospital mortality after primary PTCA without intracranial bleeding complications. For this reason, an earlier diagnosis of AMI, an earlier hospital admission and an earlier primary PTCA should be the aims of management in order to improve the outcome in women with AMI and to equalize the procedural results in the two sexes.