Interventional treatment of stable coronary artery disease in women

Abstract

Stable coronary artery disease is a common cause of death or disability in men and women, but it manifests differently in women. The impact of coronary artery disease on women has traditionally been underappreciated due to higher rates at younger ages in men. The underestimation of the severity of CAD in women has several reasons. Firstly, this can be partly attributed to the lack of awareness of women themselves who do not know that coronary disease is their first cause of mortality. Secondly, women’s symptoms are much more frequently atypical compared to those observed in men, and, finally, physicians tend to underdiagnose coronary disease in their female patients. This is particularly important for young women in whom mortality from coronary disease has not been decreasing, contrary to the male population and to older women in whom a constant mortality reduction has been reported over the past decades. In European cardiovascular clinical trials of the same period, the proportion of women enrolled varied between 16 and 25 %, although the female prevalence of clinical conditions under study in the general population was far superior to that rate. Revascularization by percutaneous coronary intervention or coronary artery bypass grafting more effectively relieves angina, reduces the use of anti-anginal drugs, and improves exercise capacity and quality of life, compared with a strategy of medical therapy alone. Usually female patients with coronary vessel disease tend to have a higher risk profile by the time they are referred for coronary intervention. It is important to underline that the best current revascularization results achieved with coronary intervention are with new-generation drug-eluting stents and for bypass grafting with maximal use of arterial grafts. Women who undergo coronary artery bypass surgery have more cardiac risk factors than men and are also more likely to experience complications such as death, heart failure, bleeding, and infarction. In women undergoing percutaneous coronary intervention, newer-generation drug-eluting stents proved safer and more effective than bare-metal stents at long-term follow-up.