Percutaneous coronary intervention in women: is sex still an issue?

Area of Science:

• Cardiology
• Vascular Biology
• Gender Medicine

Background:

• Coronary artery disease (CAD) in women exhibits distinct clinical presentations and pathophysiology compared to men.
• Women with CAD experience poorer prognoses, including increased adverse events and higher mortality rates.
• Despite a higher burden of risk factors and comorbidities, women often have less obstructive disease and more favorable plaque characteristics.

Purpose of the Study:

• To explore the sex-based differences in coronary artery disease, focusing on pathophysiology, clinical presentation, and treatment outcomes.
• To highlight the challenges in diagnosing and managing microvascular dysfunction in women.
• To assess the impact of evolving interventional techniques and devices on sex disparities in CAD.

Main Methods:

• Review of existing literature on sex differences in coronary artery disease.
• Analysis of clinical presentation, diagnostic challenges, and treatment outcomes in women versus men.
• Evaluation of the role of endothelial dysfunction and microvascular abnormalities.
• Assessment of outcomes related to revascularization procedures and drug-eluting stents (DES).

Main Results:

• Women are less likely to be referred for invasive therapy and face higher complication rates from revascularization procedures.
• Microvascular dysfunction and endothelial abnormalities may contribute to angina symptoms in women, with a worse prognosis.
• While in-hospital mortality after ST-elevation myocardial infarction is higher in women, advancements in treatments are narrowing the gender gap.
• Female sex is a predictor of increased bleeding risk, necessitating bleeding avoidance strategies.

Conclusions:

• Sex-based differences in CAD pathophysiology, hormonal impacts, and responses to treatments require dedicated investigation.
• Tailored diagnostic and management strategies, including invasive approaches for microvascular dysfunction, are crucial for women.
• Further research and development of sex-specific interventions, particularly focusing on bleeding avoidance and newer stent designs, are essential to improve outcomes for women with CAD.