Women with heart attacks benefit from stenting

Apr 7 2005

Female heart attack patients undergoing angioplasty have a higher risk of death than men, but stenting may improve their outcomes, according to a study reported in Circulation, Journal of the American Heart Association.

A new analysis of the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) trial examined gender differences in outcomes after treatment with angioplasty compared to stenting, with and without the antiplatelet agent abciximab, when women and men arrive at the hospital after a heart attack. The trial investigated the safety and efficacy of stents compared to angioplasty alone in heart attack patients.

In angioplasty, a small balloon-tipped catheter is inserted into a blocked artery, and then the balloon is inflated to open the artery. Stenting is performed in conjunction with angioplasty, wherein a mesh tube – called a stent – is positioned to help keep the unblocked artery open.

“Angioplasty is known to save lives in the setting of a heart attack and saves more lives of women than men,” said lead author Alexandra J. Lansky, M.D. “For every 1,000 patients treated with percutaneous coronary interventions, an estimated 56 deaths are prevented for women compared to 42 deaths prevented for men. There is a larger absolute benefit for women because of their higher risk profile.”

Lansky is director of clinical services for interventional cardiology at New York-Presbyterian Hospital/Columbia and associate professor of clinical medicine at Columbia University Medical Center in New York City and director of the Women’s Health Initiative at the Cardiovascular Research Foundation.

Based on the CADILLAC findings, Lansky suggested that stenting may be the preferred treatment choice for women with heart attack.

“Stenting is the best alternative among excellent treatment options for women,” she said. “There is no difference in the death rates between stenting and angioplasty, but stenting offers a substantial benefit by decreasing the recurrence rate of new blockages.”

The study involved 2,082 heart attack patients who arrived at the hospital within 12 hours after symptoms began. Patients were randomized into four treatment groups: 518 received balloon angioplasty, 528 received balloon angioplasty plus abciximab, 512 received stenting alone, while 524 received stenting plus abciximab. Women represented 27 percent of the study population, and their average age was 66. The average age for men in the study was 57.

Lansky said that more than 1 million Americans undergo angioplasty each year, but only 35 percent of these procedures are performed on women.

In this analysis, death rates were higher for women: 7.6 percent of women had died one year later compared to 3 percent of men. Also, rates of major adverse cardiac events were also higher for women at one year: 23.9 percent for women compared to 15.4 percent for men.

For the first time in a randomized, controlled clinical trial, stent use was found to significantly reduce major adverse cardiac events in women at one year, 19.1 percent for stents compared to 28.1 percent for balloon angioplasty. The need to re-intervene was reduced from 20.4 percent with balloon angioplasty to 10.8 percent with stents, a significant reduction.

Women in the study had more diabetes, hypertension and high cholesterol than men and were older than men.

The women represented a high-risk population with higher short and long-term death rates compared to men. This was explained by their older age, smaller body surface area, increased frequency of other diseases and risk factors, and the greater occurrence of in-hospital complications. Major adverse cardiac events remained greater in women than men.

The fact that the women had a smaller body size and smaller vessels “appears to be a critical factor that confers higher mortality risk in women,” Lansky said.

The study also noted that women waited longer by an average of 22 minutes to go to the hospital than men, and women had as much as a 15-minute longer delay once they arrived at the hospital until the time treatment was started.

Lansky called on women to go to the hospital as soon as they suspect the symptoms of heart attack. She urged the medical profession to speed evaluations and the time to treatment from the emergency room to the catheterization lab. This will help optimize treatment for women, she said.

Co-authors are Cody Pietras, BSc; Ricardo A. Costa, M.D.; Yoshihiro Tsuchiya, M.D.; Bruce R. Brodie, M.D.; David A. Cox, M.D.; Eve D. Aymong, M.D.; Thomas D. Stuckey, M.D.; Eulogio Garcia, M.D.; James E. Tcheng, M.D.; Roxana Mehran, M.D.; Manuela Negoita, M.D.; Martin Fahy, M.S.; Ecaterina Cristea, M.D.; Mark Turco, M.D.; Martin B. Leon, M.D.; Cindy L. Grines, M.D. and Gregg W. Stone, M.D.

The study was supported in part by Guidant Corporation and the Cardiovascular Research Foundation.

http://www.americanheart.org/