title: Unique Coronary Artery Disease Differences in Women as Related to Revascularization.
abstract: There are significant differences in coronary heart disease (CHD) in women whenever a comparison is made to men and these carry over to revascularization procedures including percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery. The coronary arteries of women are smaller, which presents additional challenges for PCI and CABG procedures. Unique atypical symptomatology in response to acute coronary syndrome (ACS) in women can confound diagnosis, women notoriously delay seeking medical help for ACS, and physicians and other caregivers have had a tendency to minimize the significance of these symptoms, contributing further to a delay in necessary care. There also appears to be an increased association of inflammation and CHD in women. The younger the female patient with CHD, the higher the mortality and that mortality clearly exceeds that of comparable male patients. For cardiovascular (CV) risk prevention in women, statins have had controversy associated with their use but overall, the proof of beneficial outcomes results from statins is also valid in women. An increased rate of adverse outcomes has been reported in women after PCI and CABG surgery. These worse clinical outcomes have persisted in contemporary years but lessened due to advancement in invasive techniques. Nevertheless, PCI that could improve clinical outcomes in women who have high-risk ACS is, unfortunately, performed on a less frequent basis and, in addition, there are greater delays involving women as compared to men. With increased clinical comorbidity associated with complex CHD in women, a lower anatomical SYNTAX score (from: SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery [SYNTAX] trial) appears necessary in order for women to achieve a similar long-term mortality benefit from CABG surgery as compared to PCI.
authors.affiliation: 326 Wethington Building, 900 South Limestone Street, Lexington, Ky 40536-0200, USA. twhayn0@uky.edu.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Whayne
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
mesh_terms: D003324:Coronary Artery Disease / Q000188:drug therapy / Q000628:therapy*; D004958:Estradiol / Q000502:physiology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007249:Inflammation; D009204:Myocardial Revascularization / Q000592:standards*; D011374:Progesterone / Q000502:physiology; D011584:Psychology; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011374:Progesterone; D004958:Estradiol