SCAI: Many knowledge gaps remain on revascularization in women
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CVD is the leading cause of death in women globally, but women are less likely to receive CV procedures than men, and not enough is known about sex differences for those procedures, a panel concluded.
To identify evidence gaps and summarize the literature on myocardial revascularization in women, the Society for Cardiovascular Angiography and Interventions published an expert consensus statement in the Journal of the Society for Cardiovascular Angiography and Interventions.
‘Consistently underrepresented’
“Women are consistently underrepresented in studies examining coronary revascularization approaches and outcomes,” J. Dawn Abbott, MD, FSCAI, professor of medicine, associate chief of faculty development and academic advancement and director of the Interventional Cardiology Fellowship Training Program at Warren Alpert Medical School of Brown University and co-chair of the document, told Healio. “The intent of this consensus statement was to rigorously review contemporary studies and highlight the certainty of data in women. This is needed now to complement to the revascularization guidelines, which provide recommendations independent of gender.”
The prevalence of CVD in U.S. women aged 20 years or older is nearly 36%, almost as high as it is for U.S. men, and increases with age in women as it does in men, Abbott and colleagues wrote.
In people younger than 55 years, PCI is performed less often in women than in men, which may partially explain why among patients in that age group with non-STEMI, women have worse in-hospital and long-term mortality rates than men, they wrote.
Where data are lacking
“Women benefit greatly from revascularization procedures and should be evaluated and treated based on guideline recommendations,” Abbott told Healio. “At the same time, physicians should recognize where data are lacking or controversial. One example of this is the relative risks and benefits of PCI compared to CABG in women.”
The knowledge gaps identified in the document include:
- the true prevalence of obstructive and nonobstructive CAD in women presenting with MI;
- optimal strategies for diagnosing and testing etiologies of MI with nonobstructive coronary arteries, which occurs disproportionately in women;
- mechanisms to reduce nontraditional sex-specific risk factors;
- whether there are sex-based differences in optimizing PCI with IVUS vs. diagnostic angiography;
- randomized trials of PCI vs. CABG in women with left main disease and/or multivessel disease;
- optimal revascularization strategies in women with chronic coronary syndromes;
- optimal tools for diagnosis and treatment of young women with non-STEMI;
- long-term outcomes of CABG vs. PCI on women with non-STEMI;
- tools to reduce symptom onset to presentation time in women with MI;
- management of nonculprit lesions in women with STEMI and multivessel disease;
- sex-specific algorithms for managing cardiogenic shock in women;
- pathogenesis of and risk factors linked to spontaneous coronary artery dissection and Takotsubo cardiomyopathy, both of which occur disproportionately in women;
- outcomes of CABG vs. PCI in women with ischemic cardiomyopathy, chronic kidney disease and/or diabetes;
- sex-specific differences in outcomes of devices to treat calcified plaque;
- randomized trials of revascularization vs. medical therapy in women with chronic total occlusion; and
- sex-specific differences in optimal antiplatelet therapy regimen following PCI.
“The hope is that investigators will design trials that are adequately powered to assure the primary outcome in women and men are equally powered,” Abbott told Healio. “In the meantime, rigorous secondary analyses of trial outcomes according to gender provide physicians with knowledge to care for female patients.”
For more information:
J. Dawn Abbott, MD, FSCAI, can be reached at jabbott@lifespan.org; Twitter: @jdawnabbott1.
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