Study finds improvement for both genders over 25-year period
MONDAY, June 9 (HealthDay News) -- The procedures used to open narrowed heart arteries work just as well in women as in men, and the results for both genders have improved steadily in recent years, new research finds.
The study in the June 17 issue of the Journal of the American College of Cardiology is a marker in a fading debate about the value for women of what cardiologists call percutaneous coronary intervention (PCI), in which a balloon-tipped catheter is inserted to open a blocked blood vessel. Older studies have reported a lower use of PCI for women and a higher death rate for those getting the intervention.
But looking at 25 years of PCI done on almost 19,000 people, Mayo Clinic cardiologists report increasing effectiveness for the most recent years and equal effectiveness for men and women when risk factors such age are taken into account.
"Women should feel reassured," study author Dr. Mandeep Singh, an associate professor of medicine, said in a statement. "Not only has there been significant improvement in PCI outcomes over time, women's outcomes are similar to those of men."
The Mayo researchers compared 7,904 people, 28 percent of them women, who had PCI between 1979 and 1995, with 10,981 people, 31 percent of them women, treated between 1996 and 2004. They found a reduction in the death rate in the 30 days after the procedure for men, from 2.8 percent in the early group to 2.2 percent in the more recent group; for women, it went from 4.4 percent in the early group to 2.9 percent in the later group.
Overall, the success rate in opening arteries was almost identical for both sexes, 89 percent for women, 90 percent for men.
The higher mortality rate for women could be explained by risk factors such as age, the report said. Women having PCI were an average of five years older than men. They were also significantly more likely to have severe chest pain, diabetes and high cholesterol.
"Improvements in procedure account for most of the gain in women," said Dr. Robert F. Wilson, a professor of interventional cardiology at the University of Minnesota, and co-author of an accompanying editorial. "One is the use of stents, because the results with stenting are better."
Stents are flexible tubes inserted after angioplasty to help keep arteries open.
"Also, anticoagulation has improved tremendously," Wilson said. "Women in general are more prone to bleeding complications, and our understanding of anticoagulation has improved over 10 years. We don't give as much of the drugs, and we have better drugs to give."
While the American Heart Association had to issue a 2005 statement saying that PCI was as helpful for women as men, "there is a growing consensus that it is as effective in women as in men," Wilson said.
Age accounts for much of the higher toll, and "heart disease tends to develop later in women, which is partly related to their hormonal condition," he said. "After menopause, the disease takes off."
The new report backs the findings of a study done in Pennsylvania several years ago, said Christopher Hollenbeak, an associate professor of surgery and public health sciences at Penn State University. That study, which he led, looked at data on more than 31,000 state residents who had PCI in 2000.
"The same conclusions they reached, we reached as well," Hollenbeak said. "When you control for the risk factors, much of the difference in outcomes goes away. Of course, we used one-year data, from 2000, and over time, physicians are changing the way they practice."
Background on PCI for women is offered by the Cleveland Clinic.
SOURCES: Robert F. Wilson, M.D., professor, interventional cardiology, University of Minnesota, Minneapolis; Christopher Hollenbeak, Ph.D., associate professor, surgery and public health sciences, Penn State University, Hershey, Pa.; June 17, 2009, Journal of the American College of Cardiology
All rights reserved