AHA urges earlier diagnoses, referrals for PCI in women


American Heart Association scientific statement

NEW YORK CITY, Feb. 1 Physicians should diagnose and provide referrals for percutaneous coronary interventions (PCI) earlier in women, the American Heart Association recommends in a statement published in Circulation: Journal of the American Heart Association.

This statement was presented today at The State Of The Heart: Go Red For Women news conference in New York City.

PCI, which includes balloon angioplasty and stenting to open blocked arteries, could prevent many coronary heart disease deaths in women each year, particularly in women who arrive at the hospital having a heart attack, according to the Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy In Women statement.

More than 1 million Americans undergo PCI each year, but only 35 percent of these procedures are performed in women, said Alexandra J. Lansky, M.D., chair of the statement writing group and director of the Women's Cardiovascular Health Initiative at the Cardiovascular Research Foundation.

This is the first time the American Heart Association has addressed in detail what is known and not known about PCI in women.

"These interventions can save lives and prevent subsequent heart attacks in these women. Now is the time to translate our findings into real-world practice," said Lansky, director of Clinical Services for Interventional Cardiology at NewYork-Presbyterian Hospital/Columbia and associate professor of clinical medicine at Columbia University Medical Center in New York City.

"One reason for the imbalance in referrals for PCI is that earlier studies suggested that women had high death and complication rates with these procedures. But this review finds that these procedures are not only safe and effective in women, but that outcomes continue to improve."

But research confirms that women may present some unique problems, Lansky said.

"There is no question that the female patient is likely to have a higher cardiovascular disease risk profile," she said. "Typically women who are referred for PCI have smaller vessels; they also have more diabetes and hypertension and are usually eight to 10 years older than men who are referred. In addition, women usually delay seeking treatment, so much so that women who have heart attacks will seek help 30 to 60 minutes later than their male counterparts. It is these factors, rather than gender, that contribute to a higher risk of death in women, and shouldn't preclude women from having these potentially life-saving treatments.

"In fact, once women are referred for PCI, the rate of blood vessels being successfully re-opened is similar to that in men," she said. The statement does not present specific recommendations for physicians, but compiles the latest evidence about the effectiveness of PCI in women. The panel identified three important areas for improving women's treatment:

  • Diagnosis and early referral for treatment. Women face great delays for stenting or angioplasty. By contrast, men are usually promptly referred for these procedures for suspected cardiovascular disease. The goal should be the same for women.
  • Further research to optimize therapy for patients with diabetes and small vessel coronary disease -- two conditions prevalent in the female population.
  • More refined treatment pathways and strategies for women with ST elevation myocardial infarction (severe heart attack in which an artery is completely blocked) where death rates and bleeding risk is higher than in men.

    Noting that the new statement is based on analysis of gender-specific evidence compiled in clinical trials over the last two decades, Lansky said more such trials are needed. "Our statement is based on the gender-specific evidence we have available to us as health care professionals. However, to truly improve outcomes in women, we need to recruit more women in future clinical trials, as female representation has been 38 percent at best, and often closer to one-quarter of the studied populations," she said.

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