Interventions in Ischemic Heart Disease

Deborah N. Kalkman, Birgit Vogel, Ridhima Goel, Roxana Mehran

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

The field of percutaneous coronary interventions (PCI) in ischemic heart disease is in continuous evolution. New insights on coronary stenting, dual antiplatelet therapy (DAPT), and mechanical support are generated daily. However, most data report on best therapies in the overall PCI population, which may not be directly applicable to women. Women are a minority in the PCI population, accounting for approximately one-third of the patient population treated with PCI. Women undergoing PCI have more comorbidities than their male counterparts. They have smaller coronary vessels and are more likely to experience radial artery spasm. As a result, trans radial access is less commonly used in women than in men. Women also have a higher chance of bleeding after PCI, which affects decision making regarding stent type and DAPT regimen. Many operators prefer stents that allow for shorter DAPT duration. Clinical outcomes after PCI in women remain less favorable compared to men, with higher rates of target lesion failure and higher all-cause death. These sex-related differences are driven by variation in comorbidities, clinical presentation, and lesion characteristics. While the field of mechanical assist devices is evolving rapidly, only very limited sex-specific data are available on this topic. Further research is needed to improve outcomes in women undergoing interventions for ischemic heart disease.

Original languageEnglish
Title of host publicationSex Differences in Cardiac Diseases
Subtitle of host publicationPathophysiology, Presentation, Diagnosis and Management
PublisherElsevier
Pages93-108
Number of pages16
ISBN (Electronic)9780128193693
DOIs
StatePublished - 1 Jan 2021

Keywords

  • Coronary stents
  • Dual antiplatelet therapy
  • Mechanical support
  • Percutaneous coronary intervention
  • Radial procedure
  • Sex differences
  • Stent diameter
  • Women

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