[Effect of sex on revascularization strategy]
Rosa A Hernández Antolín1, José E Rodríguez Hernández
1Unidad de Hemodinámica, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Martín Lagos s/n, 28040 Madrid, Spain. rhernandez_antolin@hotmail.com
Insights
Women with ischemic heart disease benefit from revascularization, but face higher risks. Careful patient selection and collaboration between specialists ensure optimal treatment for coronary artery disease in women.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Ischemic heart disease (IHD) is a leading cause of morbidity and mortality in women.
- Diagnosis in women is challenging due to atypical symptoms, underestimation of risk, and limitations of non-invasive tests.
- Coronary angiography is underutilized in women, further complicating diagnosis and treatment decisions.
Purpose of the Study:
- To review the benefits and risks of revascularization procedures for ischemic heart disease in women.
- To compare outcomes between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in female patients.
- To emphasize the importance of individualized treatment selection and multidisciplinary collaboration.
Main Methods:
- Review of current literature on revascularization strategies for ischemic heart disease in women.
- Analysis of outcomes, including benefits and complications, of PCI and CABG.
- Discussion of factors influencing procedural choice and post-procedural management.
Main Results:
- Women with IHD, including angina and myocardial infarction, derive similar benefits from PCI and CABG as men.
- Hemorrhagic complications and periprocedural mortality are slightly higher in women undergoing revascularization, though this gap is narrowing.
- Drug-eluting stents, arterial grafting, and off-pump procedures show equal efficacy in both sexes.
Conclusions:
- Revascularization is a safe and effective treatment for ischemic heart disease in women.
- Optimal selection of PCI versus CABG requires careful consideration of patient-specific factors and shared decision-making.
- Close collaboration between interventional cardiologists and cardiac surgeons is crucial for consistent and appropriate treatment planning.
Abstract:
Cardiovascular disease and, in particular, ischemic heart disease are major causes of morbidity and mortality in women. Diagnosis of ischemic heart disease in women is made more difficult by the occurrence of atypical symptoms, a perception that the risk is low, the limited accuracy of non-invasive tests, and underuse of coronary angiography. Women with ischemic heart disease, with either stable or unstable angina or non-Q wave or ST-elevation myocardial infarction, benefit as much as men from percutaneous or surgical revascularization. However, hemorrhagic complications occur more often in women and periprocedural mortality is slightly higher with both techniques, though the sex difference has tended to decrease in recent years. Moreover, drug-eluting stents, arterial revascularization, and off-pump procedures are equally beneficial to men and women. Nevertheless, strict control of risk factors is essential following any revascularization procedure. Selecting which of the 2 revascularization procedures is more appropriate depends on the patient's age and comorbid conditions, the number, location and type of coronary lesions, ventricular function, and the patient's preferences, among other factors. Nowadays, a significant number of patients can be revascularized using either technique. Therefore, open discussion of each case and close collaboration between interventional cardiologists and surgeons are essential so that joint decisions about the most appropriate treatment can be made in a consistent manner.
