Revascularization versus optimal medical therapy in chronic coronary syndrome in women: A systematic review

We performed a systematic review to compare revascularization to optimal medical therapy (OMT) alone in reducing mortality and improving cardiovascular outcomes in women with chronic coronary syndrome, due to obstructive coronary artery disease.

PUBMED/EMBASE and CINAHL were searched for randomized trials comparing routine revascularization versus OMT alone in patients with chronic coronary syndrome. We extracted data regarding cardiovascular death, myocardial infarction, heart failure and relief of angina in women. Published data from sub-group analysis in women were the primary sources.

Four randomized clinical trials that enrolled 10722 patients followed for a mean 4.5 years of follow-up fulfilled our inclusion criteria. Two thousand four hundred one women were included in these trials. Male patients with preserved left ventricular systolic function and without left-main disease, formed the majority of trial participants. Compared with medical therapy alone, revascularization was not associated with a reduced risk of death or myocardial infarction, among women. Greater relief from angina and reduction in heart failure hospitalization was observed with revascularization in women in some studies.

Routine revascularization was not associated with improved survival or decreased rates of myocardial infarction in women when compared to OMT as an initial approach. Better relief from angina, and decreased hospitalizations due to heart failure were noted. Women continue to be underrepresented in clinical trials which limits our ability to draw robust conclusions.