Reperfusion and revascularization strategies for coronary artery disease in women
S. B. Eysmann and P. S. Douglas
Harvard-Thorndike Laboratory, Beth Israel Hospital, Boston, MA 02215.
OBJECTIVE--One third of all deaths in women in the United States each year
are attributable to coronary heart disease. Gender differences exist in the
course and management of patients with coronary heart disease. Few
randomized trials have been conducted in women to evaluate effective
therapeutic strategies. With the aim of developing rational approaches to
women with coronary heart disease, we review gender-related outcomes with
coronary revascularization and reperfusion therapies. DATA
SOURCE--English-language journal articles and reviews on the subject of
women with coronary heart disease or gender-specific responses to coronary
heart disease management, from 1970 through 1992, identified through
MEDLINE searching. STUDY SELECTION--Selected studies included only
randomized controlled trials for topics related to thrombolysis, and
articles considered to contribute significantly to the topic of women with
coronary artery disease in the case of angioplasty and coronary artery
bypass grafting. DATA EXTRACTION--Two reviewers participated in extracting
the data with the aim of presenting a balanced and comprehensive review of
the subject. DATA SYNTHESIS--Thrombolysis in acute myocardial infarction
reduces mortality in men and women, although women may have a reduced
mortality benefit compared with men. Angioplasty and the newer
interventional devices result in greater procedural morbidity but similar
if not better long-term outcomes in women. Women may have a greater
mortality rate than men with coronary artery bypass surgery, although
studies suggest that outcome after bypass surgery may depend more on
coronary size and preoperative risk factors than on gender itself.
CONCLUSIONS--The existence of gender differences in the course of coronary
heart disease and response to revascularization and reperfusion strategies
suggests the need for unique clinical approaches to the female patient with
coronary heart disease and stresses the importance of developing randomized
trials that enroll adequate numbers of women and that are designed to
answer gender-specific questions.
