Comparative safety and efficacy of percutaneous transluminal coronary angioplasty in men and in women

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Abstract
In early reports of percutaneous transluminal coronary angioplasty (PTCA) in women, the complication rate was higher and the success rate lower than in men. From December, 1980, to December, 1986, 969 women aged 61 (32––84) years and 2,727 men aged 57 (27––84) years underwent PTCA, at our institution. At the time of PTCA 26% of the women had functional class IV angina pectoris compared to 16% of the men (P<0.005). Women more often had hypertension (56% vs 39%), left ventricular hypertrophy, diabetes mellitus (19% vs 11%; P<0.0005), and family history of coronary artery disease than men. Significantly more of the men (74%) smoked than did the women (53%). The success rate in women was 93% as compared to an angiographic success rate in 2,727 men of 93.5% (ns). The rate of emergency bypass surgery in women was 3.8% as compared to 3.2% in men (ns). The death rate was 0.3% in women as compared to 0.09% in men. Women underwent more PTCA of the left anterior descending coronary artery (52% vs 48% of lesions in men; P<0.05) and right coronary artery (32% vs 27% in men; P<0.0005). Fewer of the women (9%) had had previous bypass surgery than had the men (15% P<0.0005). Procedural details, including balloon diameter, vessel diameter, lesion response pressure, inflation number, and maximum inflation pressures used at PTCA, were not different between men and women. Women had significantly more ST segment shift of 1 mm of more at the time of balloon inflation than men (P<0.0005). Thirty‐five percent of women demonstrated intimal tear at the site of PTCA as compared to 30% of men (P<0.0005). Men and women demonstrated similar angiographic change following successful PTCA, with reduction of stenosis from 79% ± 13% and reduction in gradient from 52 ± 19 mmHg to 11 ± mmHg. Women demonstrated more guiding catheter problems with PTCA (14% vs 11% in men; P<0.05) and more damping of the pressure with the guiding catheter (6% vs 3% in men; P<0.0005). One percent of women had a problem with vascular access compared to 0.3% of men (P<0.05). Of the first 300 women undergoing PTCA at our institution, 94% underwent single‐vessel PTCA, whereas 86% of the last 300 women underwent single‐vessel PTCA. The emergency bypass surgery rate declined from 5.7% to 3.7%. At follow‐up of 20 ± 12 (1––69) months, chest discomfort was improved in 90% of women and in 89% of men; 2.9% of women had suffered a myocardial infarction as compared to 2% of men; 4.9% of women had undergone repeat PTCA as compared to 5.3% of men; and 7% of women underwent open heart surgery late after PTCA as compared to 6.8% of men. In summary, PTCA in women did not carry an increased rate of emergency bypass surgery or death as compared with that in men. The long‐term efficacy is similar to that seen in men.