Treatment: Angioplasty in Women: Risky Business?

Women with coronary artery disease face the same issues as men: they need to be treated with a procedure to open the narrowed blood vessel(s) to prevent a heart attack.

The choices include coronary artery bypass graft (CABG) surgery or percutaneous (through the skin) coronary interventions (PCI) such as percutaneous transluminal angioplasty (PTCA), atherectomy and stents. These less-invasive treatments involve inserting a catheter – a thin, hollow tube – into the narrowed vessel and passing a device through the tube to open the artery. In PTCA, a tiny balloon is pumped up inside the artery; atherectomy involves cutting out the plaque using various devoices; stents are tiny wire coils inserted into an artery to hold it open, usually used in combination with another technology.

Leveling the playing field for woman with heart disease

Treatment for cardiovascular disease should depend on the severity of the disease and the number of vessels that are narrowed – PCI is better suited for single-vessel disease. But, despite the fact that older women experience heart disease at the same rate as men and are more likely than men to have single-vessel disease, only 35 percent of the PCI procedures performed in the United States are done on women.

Why don’t women with heart disease get referred for PCI?

One reason may be that several studies done in the late 1980s suggested that women experience high mortality and complications rates with these procedures. The numbers were significant enough to make many doctors hesitate about referring women for angioplasty or atherectomy.

The American Heart Association (AHA) wants to change that. In February 2005, the AHA reported that PCI is safe and effective in women, and that new technology is improving outcomes. How can this be? Are these procedures safe for women or not?

The explanation for AHA’s statement lies in how the data are interpreted. Contemporary studies, on which the AHA is basing its comments, adjust the data for gender differences in risk factors – the fact that women who undergo PCI are eight to 10 years older than their male counterparts, have more complicating factors such as diabetes, high cholesterol and high blood pressure and naturally have smaller coronary blood vessels.

It’s these behind-the scenes risk factors, not simply gender, that add up to a higher mortality risk with PCI for women. Take the risk factors out of the equation, and disparities in mortality mostly disappear.