Study calls for more consistent use of anti-clotting medications in women

High-risk women with acute coronary syndrome benefit as much as men from a trip to the cardiac cath lab shortly after being hospitalized, according to a study reported recently at the Society for Cardiovascular Angiography and Interventions (SCAI) 29th Annual Scientific Sessions in Chicago.

The study adds important new information to an ongoing controversy: whether women with acute coronary syndromes fare better with a combination of drug therapy and watchful waiting or--like men--benefit from early angiography and percutaneous coronary intervention (PCI).

"Our findings show that women should not be denied access to the cath lab, particularly high-risk women," said Rachid Elkoustaf, MD, MPH, a senior cardiology fellow at the Henry Low Heart Center at Hartford Hospital in Hartford, CT.

Acute coronary syndromes encompass both unstable angina, or more seriously, a type of heart attack known as non -ST-segment-elevation acute coronary syndrome (NSTE ACS), a name that comes from the shape of the "ST-segment" on the electrocardiogram.

Studies have clearly shown that clinical outcomes are better when high-risk men are quickly taken to the cardiac catheterization laboratory, where an interventional cardiologist threads a catheter into the heart through a nick in an artery in the groin, injects dye to aid in viewing the artery with x-rays, and performs PCI as needed, inflating an angioplasty balloon or placing an expandable stent to open the arterial blockage.

In women, studies have reported conflicting data on whether PCI is the best treatment approach. To answer that question, Dr. Elkoustaf and his colleagues analyzed data from 488 women and 1,036 men who had NSTE ACS and were treated with PCI. Although women had a rockier hospital course than men--they were significantly more likely to need a blood transfusion or repeat PCI, for example--nine-month follow-up revealed similar rates of death and heart attack in the two groups.

Several factors other than gender may explain why women experienced more problems than men while in the hospital, Dr. Elkoustaf said. Women typically were older than men and had more health problems, such as high blood pressure, diabetes, and high blood cholesterol. More important, before PCI women were less likely to receive key anti-clotting medications as recommended by treatment guidelines, including glycoprotein IIb/IIIa inhibitors.

The study--though limited by its size and the retrospective collection of data--nonetheless has important public health implications and supports a gender-neutral approach to treating patients with ACS, Dr. Elkoustaf said.