Coronary Intervention in 2009

Cardiovascular disease remains the leading cause of death in the United States in both women and men, and each year for more than 2 decades, more women than men have died (Figure 1). In 2006, 41.3 million women (34.9%) and 38.7 million men (37.6%) were living with cardiovascular disease, reflecting mortality in 454.6 thousand women and 409.9 thousand men in 2005, with coronary heart disease responsible for 1 of every 5 deaths overall. In fact, the lifetime risk of developing coronary heart disease after age 40 is 49% in men and 32% in women. Furthermore, it is estimated that in 2009, cardiovascular disease and stroke will cost the nation $475.3 billion.1 Figure 1. Cardiovascular mortality trends for males and females in the United States, 1979 to 2005. Reproduced with permission from Ref. 1, Copyright © 2009 American Heart Association.Despite these sobering statistics, marked disparities in cardiovascular health and care, and specifically in the delivery and outcomes of coronary revascularization therapy, persist between women and men. Of the 1.3 million percutaneous coronary intervention (PCI) procedures performed in 2006, only 35% were performed in women,1 despite the known benefits of this treatment, particularly in high-risk women with acute coronary syndromes (ACS)2 and ST-segment elevation myocardial infarction (STEMI).3,4 Moreover, for those women treated with PCI, unadjusted mortality (Figure 2) and (vascular and bleeding) complication rates (Figure 3) remain significantly higher than in men.5,6 Figure 2. In-hospital and late mortality rates in women versus men after PCI. NACI indicates New Approaches to Coronary Intervention; NCN, National Cardiovascular Network; NHLBI, National Heart, Lung, and Blood Institute; WHC, Washington Hospital Center. Reproduced with permission from Reference 53.Figure 3. Meta-analysis of vascular complications in women versus men undergoing PCI. BOAT indicates Balloon Versus Optimal Atherectomy; CAVEAT, Coronary Angioplasty …