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Coronary revascularisation in women
  1. G W Mikhail
  1. Correspondence to:
    Dr Ghada W Mikhail
    Imperial College London, The North West London Hospitals Trust and St Mary’s Hospital Trust, London, UK; g.mikhail{at}btopenworld.com

Abstract

Coronary heart disease is the leading cause of death in men and women worldwide. It is still considered a disease of men and there has been little recognition of its importance in women. Gender differences exist in acute and chronic ischaemia in terms of clinical manifestations, investigations and treatment. There are clear gender differences in coronary revascularisation with a higher mortality seen in women. At the time a woman presents with coronary artery disease she is older and has more co-morbid factors. Furthermore, women have smaller coronary arteries making them more difficult to revascularise. In recent years there has been a general trend towards improved outcomes in women undergoing both surgical and percutaneous coronary intervention. The increasing use of drug eluting stents and adjunctive medical treatment as well as the use of off-pump bypass surgery needs further evaluation in terms of gender differences. This article reviews the current literature on coronary revascularisation in women.

  • ACS, acute coronary syndromes
  • AMI, acute myocardial infarction
  • BARI, bypass angioplasty revascularization investigation
  • CABG, coronary artery bypass graft
  • CADILLAC, controlled abciximab and device investigation to lower late angioplasty complications
  • CHD, coronary heart disease
  • EPIC, evaluation of 7E3 for the prevention of ischemic complications
  • EPILOG, evaluation in percutaneous transluminal coronary angioplasty to improve long-term outcome with abciximab Gp IIb/IIIa blockade
  • EPISTENT, evaluation of platelet IIb/IIIa inhibitor for stenting
  • FRISC II, Fragmin and fast revascularization during instability in coronary artery disease
  • GUSTO, global use of streptokinase and t-PA for occluded coronary arteries
  • MACE, major adverse cardiac events
  • MI, myocardial infarction
  • NHLBI, National Heart, Lung, and Blood Institute
  • PAMI, primary angioplasty in myocardial infarction
  • PCI, percutaneous coronary intervention
  • REPLACE 2, randomization evaluation in PCI linking Angiomax to reduced clinical events
  • RITA-3, randomized intervention trial of unstable angina-3
  • TACTICS TIMI 18, thrombolysis in myocardial infarction 18
  • coronary artery disease
  • coronary
  • revascularisation
  • women

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