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A new analysis of the CADILLAC trial examined gender differences in
outcomes after treatment with angioplasty compared to stenting.
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DALLAS. Female heart attack patients undergoing
angioplasty have a higher risk of death than men, but stenting
may improve their outcomes, according to a study reported in
Circulation: Journal of the American Heart Association.
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 to stenting, with and without the
antiplatelet agent abciximab, when women and men arrive at the
hospital after a heart attack. The trial investigated the safety
and efficacy of stents compared to angioplasty alone in heart
attack patients.
In angioplasty, a small balloon-tipped catheter is inserted into
a blocked artery, and then the balloon is inflated to open the
artery. Stenting is performed in conjunction with angioplasty,
wherein a mesh tube – called a stent – is positioned to help
keep the unblocked artery open.
“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, M.D. “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,” she said. “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 heart attack patients who arrived at
the hospital within 12 hours after symptoms began. 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. The average age for men in the
study was 57.
Lansky said that more than 1 million Americans undergo
angioplasty each year, but only 35 percent of these procedures
are performed on women.
In this analysis, death rates were higher for women: 7.6 percent
of women had died one year later compared to 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 to 15.4
percent for 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 to 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.
Women in the study had more diabetes, hypertension and high
cholesterol than men and were older than men.
The women represented a high-risk population with higher short
and long-term death rates compared to men. This was explained by
their older age, smaller body surface area, increased frequency
of other diseases and risk factors, and the greater occurrence
of in-hospital complications. Major adverse cardiac events
remained greater in women than men.
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.
Co-authors are Cody Pietras, BSc; Ricardo A. Costa, M.D.;
Yoshihiro Tsuchiya, M.D.; Bruce R. Brodie, M.D.; David A. Cox,
M.D.; Eve D. Aymong, M.D.; Thomas D. Stuckey, M.D.; Eulogio
Garcia, M.D.; James E. Tcheng, M.D.; Roxana Mehran, M.D.;
Manuela Negoita, M.D.; Martin Fahy, M.S.; Ecaterina Cristea,
M.D.; Mark Turco, M.D.; Martin B. Leon, M.D.; Cindy L. Grines,
M.D. and Gregg W. Stone, M.D.
The study was supported in part by Guidant Corporation and the
Cardiovascular Research Foundation.
Editor’s note: The American Heart Association’s Go Red For Women
program offers information and educational tools for women about
heart disease. For more information, visit the Go Red For Women
Web site or call 1-888-MY-HEART.
Statements and conclusions of study authors that are published
in the American Heart Association scientific journals are solely
those of the study authors and do not necessarily reflect
association policy or position. The American Heart Association
makes no representation or warranty as to their accuracy or
reliability.
NR05 – 1039 (Circ/Lansky)
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| Article reviewed by: |
Dr. Tamer Fouad, M.D.
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