doi: 10.1161/01.CIR.0000048895.18974.6B
(Circulation. 2003;107:375.)
© 2003 American Heart Association, Inc.
Editorial |
Coronary Revascularization in Women in 2003
Sex Revisited
From Boston Medical Center, Boston, Mass.
Correspondence to Alice K. Jacobs, MD, Boston Medical Center, 88 East Newton St, Boston, MA 02118. E-mail alice.jacobs@bmc.org
Key Words: Editorials • angioplasty • bypass • sex • coronary artery disease
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
During the past 3 decades, numerous and remarkably consistent studies have reported sex differences in the epidemiology, prevention, diagnosis, and clinical manifestations of coronary artery disease,1 and, especially noteworthy, in the sex differences in patients undergoing coronary revascularization, where a disturbingly higher mortality rate has been noted in women.2,3 In fact, multiple paradoxes have been observed. Differences between women and men in the extent of epicardial coronary artery disease in relation to risk factors and the degree of stable and unstable angina, in the relationship between congestive heart failure and left ventricular systolic function, and recently, in the higher in-hospital mortality after revascularization in younger but not older women in comparison to men have been noted.4 It has been suggested that improvements in procedural technology and technique, particularly the increasing performance of off-pump procedures and use of heparin bonded circuits, and the widespread use of stents and adjunctive pharmacotherapy in patients undergoing both coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) would improve outcomes in women. Therefore, it is timely to review the current status and issues concerning coronary revascularization in women.
Clinical, Angiographic, and Procedural Characteristics
Virtually all single-center and large-scale multicenter registries have reported that in comparison to men, women undergoing CABG or PCI have more comorbid disease, are older, are smaller in size, and have a higher prevalence of hypertension, diabetes mellitus, hypercholesterolemia, peripheral vascular disease, and unstable angina, as well as more severe (Canadian Cardiovascular Society class III–IV) angina. Despite a lower prevalence of previous myocardial infarction and
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