June 9, 2008 -- Doctor's may think angioplasty and stents work better in men than in women -- but women do just as well after artery-unclogging procedures, a Mayo Clinic study shows.
As it turns out, women have been doing as well as men for more than a decade. But the widespread assumption that women do worse after angioplasty means that women account for only 30% of the 1 million artery-opening procedures performed each year in the U.S. This despite the fact that heart disease is the No. 1 killer of women.
During angioplasty, a catheter is threaded through an artery into a plaque-narrowed area. A balloon is inflated to widen the artery. Usually a mesh tube called a stent is used to prop open the artery. Doctors use the term "percutaneous coronary intervention" or PCI to refer to heart procedures in which catheters are threaded into heart arteries.
"Women are less likely than men to be referred for invasive procedures, including coronary angiography and PCI," study investigator Mandeep Singh, MD, MPH, says in a news release. "Raising awareness among physicians will help us overcome this referral bias. The decision to refer a patient for PCI should not be influenced by gender."
Women have narrower arteries than men, so older equipment and older techniques may have contributed to poorer outcomes in the past. And by the time they get heart disease, women tend to be older than men, so by the time they need PCI they may have more health problems.
But recent studies have suggested that when male and female patients are matched for disease stage and other health issues, women do as well as men. So Singh and colleagues analyzed data collected on nearly 19,000 men and women who underwent PCI at the Mayo Clinic from 1979 to 2004.
Both men and women did better when treated from 1996 to 2004 than they did when treated from 1979 to 1995. Once researchers matched men and women for age, amount of blockage, and general health status, the women did just as well as the men.
In an editorial accompanying the Singh team's report in the June 17 issue of the Journal of the American College of Cardiology, University of Minnesota cardiologists Robert F. Wilson, MD, and Ganesh Raveendran, MD, note that "what's good for the gander is now good for the goose."
"This is very good news for women," Wilson says in a news release. "Over the last decade, we have dramatically improved the tools used for angioplasty, from new stents to keep the artery open to blood thinners to prevent clotting and heart attacks."
Indeed, Singh and colleagues believe the improvements seen in both women and men include new technologies, more doctor experience, and better adherence to medications by patients.
Wilson and Raveendran note that women's PCI outcomes improved at the same time stent use became common. They suggest stents may be the single biggest factor contributing to better outcomes for women.
They wonder, however, whether women should receive PCI as often as men do now -- not because women might do worse, but because PCI may be overused in men.
"Maybe we are focusing too much on how women are treated and not enough on overtreatment in men," they suggest.