Interventional cardiology

Women undergoing PCI have a long-term survival advantage despite gender inequity in care

Women undergoing PCI may have a long-term survival advantage over men, and their outcomes could be even better if they received equal, guideline-based care, according to an Australian cardiologist.

A review of 54,440 PCI patients showed women had greater overall survival at median follow-up 2.5 years (HR: 0.76, 95% CI: 0.66–0.87, P < 0.001), despite being older, having higher rates of diabetes and renal impairment and being more likely to have had femoral artery access over the recommended radial access, Austin Health cardiologist, Dr Alexandra Murphy and her team wrote in The American Journal of Cardiology.

“A current theory to partially account for this relates to the more efficient vascular tissue repair evident in post-menopausal women,” they said.

“Additionally, the protective effect of oestrogen results in lower mortality in women with pre-dialysis renal impairment; compared with men.”

Femoral artery access was associated with increased risk of major bleeding across PCI patients and meant more women experienced major bleeding to 30 days post-surgery than men, the study showed.

Although smaller vessel size and body surface area can account for some switches from radial to femoral access in women, it didn’t necessarily explain all cases, Dr Murphy told the limbic.

Women were also underrepresented in the PCI patient population, making up only a quarter of the study group.

“The finding is consistent with a pooled analysis of recent randomised trials where only 27% of patients were women,” the authors wrote.

Dr Murphy said gender-based differences in CAD presentation may only partly account for the discrepancy.

“The classic picture of someone having a heart attack is an overweight, middle-aged man — truck driver-esque — clenching his chest and presenting with central crushing chest pain,” Dr Murphy said.

“Whereas women, we know, are more likely to have atypical symptoms, less likely to have the classic advertised issues of central chest pain. They can often have abdominal pain, nausea and neurological symptoms, and so that can lead to a delay in presentation, a delay in investigation, and all of that we know has prognostic implication.”

It also meant women were less likely to receive revascularisation for obstructive CAD, the paper said.

Better advertising of women’s CAD symptoms could help improve their access to care, Dr Murphy suggested.

Ultimately, however, women should get equal, guideline-based care, as a public health priority, she said.

“We know that the benefit received from intervention — both from a pharmacotherapy perspective as well as an interventional perspective — has equal benefit in men and women. So there is no sex discriminant that would give reasoning behind withholding these treatments from women.”

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