Gender-based issues in interventional cardiology: a consensus statement from the Women in Innovations (WIN) initiative.

San Raffaele Scientific Institute, Invasive Cardiology Unit, Milan, Italy.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (Impact Factor: 3.17). 02/2010; 5(7):773-9. DOI: 10.1002/ccd.22327
Source: PubMed

ABSTRACT Cardiovascular disease (CVD) is the leading cause of mortality in women, yet studies have suggested that it is often under-recognized. Of particular concern is the apparent suboptimal treatment of women in comparison to men, with less revascularisation and use of evidence-based medications. The Women in Innovations group of cardiologists aims to highlight these issues and change perceptions to optimize the treatment of female patients with CVD, to support future research, and to encourage and guide training of female interventional cardiologists.

1 Bookmark
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The anatomical SYNTAX score is advocated in European and US guidelines as an instrument to help clinicians decide the optimum revascularisation method in patients with complex coronary artery disease. The absence of an individualised approach and of clinical variables to guide decision making between coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) are limitations of the SYNTAX score. SYNTAX score II aimed to overcome these limitations. SYNTAX score II was developed by applying a Cox proportional hazards model to results of the randomised all comers SYNTAX trial (n=1800). Baseline features with strong associations to 4-year mortality in either the CABG or the PCI settings (interactions), or in both (predictive accuracy), were added to the anatomical SYNTAX score. Comparisons of 4-year mortality predictions between CABG and PCI were made for each patient. Discriminatory performance was quantified by concordance statistics and internally validated with bootstrap resampling. External validation was done in the multinational all comers DELTA registry (n=2891), a heterogeneous population that included patients with three-vessel disease (26%) or complex coronary artery disease (anatomical SYNTAX score ≥33, 30%) who underwent CABG or PCI. The SYNTAX trial is registered with, number NCT00114972. SYNTAX score II contained eight predictors: anatomical SYNTAX score, age, creatinine clearance, left ventricular ejection fraction (LVEF), presence of unprotected left main coronary artery (ULMCA) disease, peripheral vascular disease, female sex, and chronic obstructive pulmonary disease (COPD). SYNTAX score II significantly predicted a difference in 4-year mortality between patients undergoing CABG and those undergoing PCI (p(interaction) 0·0037). To achieve similar 4-year mortality after CABG or PCI, younger patients, women, and patients with reduced LVEF required lower anatomical SYNTAX scores, whereas older patients, patients with ULMCA disease, and those with COPD, required higher anatomical SYNTAX scores. Presence of diabetes was not important for decision making between CABG and PCI (p(interaction) 0·67). SYNTAX score II discriminated well in all patients who underwent CABG or PCI, with concordance indices for internal (SYNTAX trial) validation of 0·725 and for external (DELTA registry) validation of 0·716, which were substantially higher than for the anatomical SYNTAX score alone (concordance indices of 0·567 and 0·612, respectively). A nomogram was constructed that allowed for an accurate individualised prediction of 4-year mortality in patients proposing to undergo CABG or PCI. Long-term (4-year) mortality in patients with complex coronary artery disease can be well predicted by a combination of anatomical and clinical factors in SYNTAX score II. SYNTAX score II can better guide decision making between CABG and PCI than the original anatomical SYNTAX score. Boston Scientific Corporation.
    The Lancet 02/2013; 381(9867):639-50. · 39.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objetivos A mortalidade na mulher após angioplastia primária (ICP-P) é superior à do homem. Contudo, permanece contraditório o papel do sexo poder ser fator de risco independente para mortalidade no contexto de enfarte agudo do miocárdio com supradesnivelamento de ST (EAMST). Com base no Registo Nacional de Cardiologia de Intervenção (RNCI), pretendemos avaliar como é que o género feminino influencia o prognóstico a curto prazo nos doentes com EAMST submetidos a ICP-P a nível nacional. Métodos De 60 158 doentes incluídos prospetivamente no RNCI de 2002-2012, incluímos na análise 7544 doentes com EAMST tratados por ICP-P, dos quais 25% foram mulheres. Utilizámos modelos de regressão logística e ajustamento por propensity score para avaliar o impacto do sexo na mortalidade hospitalar. Resultados As mulheres foram mais idosas (68±14 versus 61±13, p<0,001), mais diabéticas (30 versus 21%, p<0,001) e hipertensas (69 versus 55%, p<0,001). Os homens foram revascularizados mais cedo (71 versus 63% nas primeiras 6 horas, p<0,001). Choque cardiogénico foi mais frequente nas mulheres (7,1 versus 5,7%, p=0,032). Estas apresentaram um pior prognóstico a curto prazo, com 1,7 x maior risco de morte intra-hospitalar (4,3 versus 2,5%; IC 95% 1,30-2,27; p<0,001). Utilizando um modelo de regressão ajustado através de um propensity score, o sexo deixa de ser preditor de mortalidade hospitalar (OR 1,00; IC 95% 0,68-1,48; p=1,00). Conclusões No RNCI as mulheres com EAMST tratadas com ICP-P apresentaram maior risco cardiovascular, um acesso menos atempado a ICP-P e um pior prognóstico. Contudo, após ajustamento do risco, o género feminino deixa de ser preditor independente de mortalidade hospitalar.
    Revista Portuguesa de Cardiologia (English Edition). 06/2014;
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This manuscript is focused around two key messages from the current Guidelines of the European Society of Cardiology on ST elevation myocardial infarction; the need to use primary angioplasty whenever timely and effectively applicable and the importance of organisational changes in the emergency system to implement this indication. Based on a review of the trials motivating these guidelines and the successful experience of many European countries, practical indications are provided on the methods to overcome resistances and malpractices that prevent the delivery of optimal care in these critically ill patients.
    Global cardiology science & practice. 01/2012; 2012(2):36-42.

Full-text (2 Sources)

Available from
May 22, 2014