Women under the age of 55 have more complications after undergoing angioplasty, new research from the Yale schools of public health and medicine has found.
Use of percutaneous coronary intervention (PCI), more commonly known as angioplasty, has grown rapidly since 1990 among both men (43 percent) and women (63 percent). The nonsurgical procedure involves running a catheter through an artery to an area of blockage in the heart. A balloon is then inflated to open the artery and improve blood flow. Oftentimes, a stent is also inserted to keep the artery open.
Judith Lichtman, an associate professor at the Yale School of Public Health and researcher at the Center for Outcomes Research and Evaluation at the Yale School of Medicine, and eight colleagues analyzed data for over one million patients undergoing PCI in the U.S. They found that complication rates were not only higher among women than men, but even higher among women younger than 55 compared to their older peers.
Overall, women were twice as likely to experience bleeding and vascular complications, while the younger women were also twice as likely to die in hospital. Complications include heart attack, congestive heart failure, stroke and renal failure. The findings were consistent regardless of whether women underwent the procedure electively or during an emergency. The study is believed to be the first large-scale study examining gender-specific complications after PCI.
“The numbers of women having these procedures is not insignificant,” said Lichtman. “It is striking that the associations are even greater for younger women, which suggests that there is something physiologically different by age. Female patients having PCI may need to be managed differently.”
In 2010, some 162,360 PCIs were performed among women in the United States.
A number of factors may contribute to the adverse outcomes, Lichtman said. Women who have the procedure are often minorities and tend to have a greater burden of comorbid conditions such as diabetes, obesity and cardiovascular risk factors than men. Women are also less likely to receive anti-coagulant medications, or if they did, to receive the correct dose, duration or timing of medication. Physiologically, women also have smaller arteries, which may make the procedure itself more complex and cause residual vascular injury. Finally, hormones such as estrogen may affect coagulation and inflammatory markers among both pre- and peri-menopausal women.
The study appears in the American Heart Journal. Yale co-authors include Yongfei Wang, MS, Sara Jones, MPH, Erica Leifheit-Limson, PhD, Leslee Shaw, PhD, Viola Vaccarino, MD, John Rumsfeld, MD, Harlan Krumholz, MD and Jeptha Curtis, MD.