It is no longer a theory. Percutaneous coronary intervention (PCI) or coronary angioplasty is the best treatment for a person presenting with STEMI (ST- elevation myocardial infarction), a heart attack caused by complete obstruction of a coronary artery.
“Only 31 percent of women know that cardiovascular disease is the leading cause of death in the U.S.; 60 percent list cancer as the leading cause of death among women.”
Miami, Florida has become the epicenter of STEMI research and education with the nation’s premier STEMI conference – LUMEN. This year’s program begins on Thursday, February 25th, and runs for two days at the Loews Miami Beach Hotel. The annual meeting brings together some of the world’s most respected interventional cardiologists, nurses, cath lab technologists and emergency medical professionals to debate and learn new techniques and procedures for saving lives and effecting challenges associated with primary PCI. This year’s program analyzes the top 10 advances in STEMI interventions and strategies for reducing door-to-balloon (D2B) times. Faculty will also debate the American Heart Association’s (AHA) Scientific Statement suggesting a lack of consistency in the use of PCI for men and women.
Every minute in the United States, a woman dies from heart disease. Heart disease is responsible for half of all deaths in women over the age of 50. “Despite the fact that more women than men die from cardiovascular disease in the United States, and despite the established benefits of PCI in reducing fatal and nonfatal ischemic complications in patients with acute myocardial infarction and high-risk acute coronary syndromes (ACS), only an estimated 33 percent of annual PCIs are performed in women,” says an American Heart Association (AHA) Scientific Statement.
According to the statement, 5.6 percent of deaths in women could be prevented annually if treated with PCI over fibrinolytic therapy.
“In the face of a rising mortality burden in women with cardiovascular disease and the established benefits of PCI in reducing both fatal and nonfatal events for women with high-risk ACS and STEMI, PCI is performed less frequently and with greater delays in women,” says the AHA.
LUMEN’s course director, Sameer Mehta, MD, FACC, MBA, is the author of the Textbook of STEMI Interventions and Cath Lab Digest’s STEMI interventions editor. Dr. Mehta has pioneered the use of PCI in STEMI patients. As director of the cardiovascular laboratory at Cedars Medical Center in Miami in the early nineties, he began to focus on acute myocardial infarction (MI) interventions, often at odds with the medical community as a whole. Over the past decade, Dr. Mehta has created the Single Individual Community Experience Registry for Primary PCI (SINCERE) database, documenting more than 500 personal interventions.
The time from the patient’s arrival at the hospital to the opening of their blocked artery, often referred to as door-to-balloon (D2B) time, should be no more than 90 minutes, as recommended by the American College of Cardiology/American Heart Associations (ACC/AHA) Clinical Guidelines for STEMI care; any longer than 90 minutes can mean irreversible damage to the heart muscle.
Even with the benefit of PCI, the AHA statement acknowledges, “women consistently tend to have worse clinical outcomes than those of men; most of these worse outcomes are explained by the higher risk profile of women.”
“The increased in-hospital mortality of women undergoing elective and primary PCI as compared with men, although not consistently observed, appears at least in some studies to represent a complex interplay of clinical factors such as delayed onset of disease, older age, smaller body surface area, and co-morbidities at the time of presentation.”
According to the Women’s Heart Foundation, “women take 2-4 hours longer than men to respond to symptoms of heart attack, limiting the beneficial use of some newer treatments.” One reason may be lack of education: “Only 31 percent of women know that cardiovascular disease is the leading cause of death in the U.S.; 60 percent list cancer as the leading cause of death among women.”
“In the first year after a heart attack, women are 50 percent more likely to die than men – especially young women. In the first six years after a heart attack, women are almost twice as likely to have a second heart attack,” says the Texas Heart Institute.
Dr. Mehta and the faculty of LUMEN will discuss the issues associated with women’s cardiac care. “D2B times are the relatively low-hanging fruit in STEMI interventions. The next important step for operators is to ensure a high-quality result for their STEMI procedures, one that achieves an excellent myocardial blush grade, a compulsive thrombectomy and restoration of left ventricular function, and achieve such results with consistency both during working hours as well as during off hours and on weekends.”
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