Women with an acute myocardial infarction who undergo angioplasty have a higher risk of death than men, but stenting may improve their outcomes, according to an article in the April 6th issue of Circulation.

A new analysis of the CADILLAC (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications) trial examined gender differences in outcomes after treatment with angioplasty compared with stenting, with and without the antiplatelet agent abciximab, for women and men admitted for an acute myocardial infarction. The trial investigated the safety and efficacy of stents compared with angioplasty alone in this patient population.

“Angioplasty is known to save lives in the setting of a heart attack and saves more lives of women than men,” said lead author Alexandra J. Lansky, MD. “For every 1,000 patients treated with percutaneous coronary interventions, an estimated 56 deaths are prevented for women compared to 42 deaths prevented for men. There is a larger absolute benefit for women because of their higher risk profile.”

Lansky is director of clinical services for interventional cardiology at New York-Presbyterian Hospital/Columbia and associate professor of clinical medicine at Columbia University Medical Center in New York City and director of the Women’s Health Initiative at the Cardiovascular Research Foundation.

Based on the CADILLAC findings, Lansky suggested that stenting may be the preferred treatment choice for women with heart attack: “Stenting is the best alternative among excellent treatment options for women. There is no difference in the death rates between stenting and angioplasty, but stenting offers a substantial benefit by decreasing the recurrence rate of new blockages.”

The study involved 2,082 acute myocardial infarction patients who arrived at the hospital within 12 hours of symptom onset. Patients were randomized into four treatment groups: 518 received balloon angioplasty, 528 received balloon angioplasty plus abciximab, 512 received stenting alone, while 524 received stenting plus abciximab. Women represented 27 percent of the study population, and their average age was 66 years. The average age for men in the study was 57 years.

In this analysis, death rates were higher for women: 7.6 percent of women had died one year later compared with 3 percent of men. Also, rates of major adverse cardiac events were also higher for women at one year: 23.9 percent for women compared with 15.4 percent for men. Women in the study had more diabetes, hypertension and high cholesterol than men and were older than men.

For the first time in a randomized, controlled clinical trial, stent use was found to significantly reduce major adverse cardiac events in women at one year, 19.1 percent for stents compared with 28.1 percent for balloon angioplasty. The need to re-intervene was reduced from 20.4 percent with balloon angioplasty to 10.8 percent with stents, a significant reduction.

The fact that the women had a smaller body size and smaller vessels “appears to be a critical factor that confers higher mortality risk in women,” Lansky said.

The study also noted that women waited longer by an average of 22 minutes to go to the hospital than men, and women had as much as a 15-minute longer delay once they arrived at the hospital until the time treatment was started. Lansky called on women to go to the hospital as soon as they suspect the symptoms of heart attack. She urged the medical profession to speed evaluations and the time to treatment from the emergency room to the catheterization lab. This will help optimize treatment for women, she said.